Camden Cancer Education Event Imogen Staveley GP Prince

Camden Cancer Education Event Imogen Staveley GP, Prince of Wales Medical Centre Cancer Clinical Lead Camden CCG @imogenstaveley @camden_ccg

Camden Updates 1. Direct access to test remains limited. • Upper GI endoscopy at UCLH is not yet reaching 2 ww targets. • Take care not to assume 2 ww when urgent written on a form to RF or UCLH. • Best currently to do a 2 ww if you are concerned about cancer rather than direct access diagnostics. 2. Safety-netting important especially when 2 ww diagnostics start. Useful template available and video explaining how to use on CCG website. 3. Cancer in the planned care LIS

Camden Updates (II) 4. Community Links – Screening and community education 5. CRUK/Camden CCG pharmacy pilot 6. Email 2 ww forms/e-referral – no more fax 7. Multidisciplinary Diagnostic Centre Pilot ongoing 8. q. FIT pilot

Directly age-standardised rate per 100, 000 population by route (2006 -2013)

Cancer care reviews in your practice: Timing – how long after diagnosis? Who completes the review? Format of the review – face to face; telephone Practice template or other template used? What are the essential elements of a cancer care review?

Cancer Care Review I • Move to cancer being thought of as a long-term condition • Evidence that holistic management leads to better health outcomes with less morbidity and mortality • An extended consultation e. g. 20 -30 mins carried out 6 months after a person’s diagnosis • Encourage patient to bring family/carer/friend • Ensure patient understands the reason for the appointment in advance of it so they can prepare

Treatment Summary • Currently few of these being sent out but the numbers will be increasing over the coming months • Basis for Cancer Care Review

Dear Dr X Re: Add in patient name, address, date of birth and record number Your patient has now completed their initial treatment for cancer and a summary of their diagnosis, treatment and ongoing management plan are outlined below. The patient has a copy of this summary. Diagnosis: Summary of Treatment and relevant dates: Date of Diagnosis: Possible treatment toxicities and / or late effects: Organ/Staging Local/Distant Treatment Aim: Advise entry onto primary care palliative or supportive care register Yes / No DS 1500 application completed Yes/No Prescription Charge exemption arranged Yes/No Alert Symptoms that require referral back to specialist team: Contacts for re referrals or queries: Secondary Care Ongoing Management Plan: (tests, appointments etc) Other service referrals made: (delete as nec) District Nurse AHP Social Worker Dietician Clinical Nurse Specialist Psychologist Benefits/Advice Service Other Required GP actions in addition to GP Cancer Care Review (e. g. ongoing medication, osteoporosis and cardiac screening) Summary of information given to the patient about their cancer and future progress: Additional information including issues relating to lifestyle and support needs:

Case 1 • 45 year old self-employed lady treated for breast cancer and now in remission. She has had 6 months off work and feels she will be able to return to work in 2 months time. • What issues do you think you would need to cover in the cancer care review? • What resources could help you?

Case 1 • Financial support available whilst off work for so long • Consideration about side-effects of treatment e. g. lymphoedema • Health promotion • How has affected life at home and relationships with loved ones • Impact on children • Signs of recurrence and what to do • Self-management resources

Case 2 • 78 year old man treated for bowel cancer. Has had palliative bowel resection and now has a colostomy. He also has COPD. • What issues do you think you would need to cover in the cancer care review? • What resources could help you?

Case 2 • Symptom control • Consider palliative care referral • Ongoing management of COPD • Medication review • Financial support • How is he managing at home? • How is he managing with colostomy? • If any deterioration, what to do, crisis plan.

Cancer Care Review II • Check patients understanding of their treatment and the possible physical/psychological consequences • Check patient knows when and where to re-present with worrying signs/symptoms • Signposting related to specific physical/social needs related to cancer e. g. lymphoedema service/psychology • Financial needs and Carer needs • Provide patient with resources that enables them to self-manage e. g. Macmillan website • Consider health promotion • Medication review • Complete a template and consider giving patient a copy

Nicola Macdonald, Gynaecology Consultant Ferina Ismail, Dermatology Consultant Sajir Mohamed, Haematology Consultant ‘Speed Dating’ Edward Seward, Gastrointestinal Consultant

Resources: • Cancer Care Review and Cancer as a long term condition http: //www. rcgp. org. uk/clinical-and-research/toolkits/~/media/5 DD 400 CB 536 C 486 FB 86 C 25 A 1 D 7 F 7 ED 50. ashx http: //www. ncsi. org. uk/what-we-are-doing/cancer-care-review/ https: //www. england. nhs. uk/wp-content/uploads/2016/04/cancer-guid-v 1. pdf https: //www. myhealth. london. nhs. uk/system/files/Cancer%20 Care%20 Review. pdf • Treatment Summaries http: //www. macmillan. org. uk/aboutus/healthandsocialcareprofessionals/newsandupdates/macvoice/treatmentsu mmaryatooltoimprovecommunication. aspx • Directory of Services http: //londoncancer. org/our-work/whole-pathway-improvement/directory-of-services/