National Cancer Rehabilitation Pathways. Rachel Atkinson AHP Lead May 2011

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1 National Cancer Rehabilitation Pathways Rachel Atkinson AHP Lead May 2011

2 National Cancer and Palliative Care Rehabilitation workforce Project One of the objectives was to produce 9 tumour specific, evidence based rehabilitation care pathways 10 symptom specific pathways of care with defined therapy interventions

3 The cancer sites included in the project are Breast Lung Head and Neck Brain and CNS Upper GI (Oesophagogastric and Hepatobiliary) Colorectal Gynaecology Urology

4 Awaiting Haematology Sarcoma Skin Currently these are being prioritised and confirmation of funding is awaited

5 Evidence Base 8 national workshops (Jan March 2009) covering 21 care pathways (site and symptom) 150 representatives (Special interest groups and professionals with specific clinical interest) Aim To develop both tumour and symptom specific pathways for cancer rehabilitation

6 Achieved by highlighting potential intervention required by the patient or carers at each stage of the cancer pathway Examining the evidence resulting from the evidence review Each intervention agreed as either supported by evidence or considered by experts to be clinically good practice

7 Draft pathways were written Changes based on comments and suggestions from delegates at the workshops Verifications, tidying, wording made consistent, duplications of interventions removed Interventions categorised into themes

8 Structure of pathways The structure and stages of the site specific are similar The interventions are more unique The information relating to palliative care and end of life care was very similar for all cancer sites The level and intensity for a specific intervention may vary but the interventions are common across most disease sites

9 The structure and stages of all tumour site specific rehabilitation pathways are Pre-diagnosis Upper G.I and Head and Neck Diagnosis Treatment Post treatment Monitoring and survivorship Palliative care End of Life care

10 Sub-headings for types of interventions: Assessment Respiratory function Cognitive and Psychological Factors Work, leisure and Activities of daily living Exercise and well being Information/support Mobility Nutrition Referral / Liaison Voice and swallowing Equipment provision Communication Fatigue management Pain management Skin care

11 Symptom specific pathways Twelve common symptom pathways have been developed and published separately They are highlighted in drop down menus in the main site specific pathways at stages where they may be relevant

12 Symptom Pathways Breathlessness Pain Lymphoedema Spinal cord compression Continence Fatigue and Energy management Mobility and Loss of function Anorexia/cachexia/ weight loss Dysphagia Communication difficulties

13 To date Pathways launched January 2010 Piloted Audited late User involvement Group workshops

14 Future national work Review to make user friendly To integrate the pathways onto map of medicine Develop remaining three pathways

15 National Cancer Peer Review Programme

16 National Cancer Peer Review Programme Rehabilitation Measures Cancer Site Specific Rehabilitation Measures (08-1E-102v to 08-1E-112v) The network cancer rehabilitation group should agree rehabilitation pathways with each network site specific group for the cancer site(s) which it deals with. The pathways should specify: the particular clinical indications for referral to rehabilitation services; the relevant intervention or procedure or therapy required; the contact points for referrals.

17 For each pathway A single integrated rehabilitation pathway should be agreed with each NSSG, which covers any or all of the four AHPs as relevant The network cancer rehabilitation group should agree the rehabilitation pathway for patients with breast cancer. Compliance: The guidelines agreed by the network cancer rehabilitation lead and the chair of the (site specific) cancer NSSG.

18 Our approach During 2010 attended each site specific NSSG Presented pathways to the groups (presentation available on East Midlands Cancer Network website) Ideally we would like to integrate these pathways into the site specific pathways already in place Baseline rehabilitation currently available within each site specific care pathway Develop a service needs assessment based on any gaps

19 Compliance with these 12 measures was achieved for the East Midlands Cancer Network. Our next step is today and scoping Cancer rehabilitation interventions across the East Midlands provided in different sectors.

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