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Rehabilitation in Lung Cancer

Rehabilitation in Lung Cancer

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Rehabilitation in Lung Cancer

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  1. Rehabilitation in Lung Cancer Jo Bayly Project Lead AHP Merseyside & Cheshire Cancer Network December 14th 2009

  2. Aim of presentation • Rehabilitation pathway for patients with lung cancer • Commissioning Lung Cancer Rehabilitation • Implications for lung cancer services in MCCN

  3. National Context • The Cancer Plan (DH 2008) • Manual for Cancer Services (2008) Rehabilitation measures • End of Life Care Strategy (DH 2008) • Transforming in-patient & community care (2008) • World Class Commissioning • Darzi; High Quality for All (2008) • Cancer Reform Strategy (DH 2007) • NICE IOG Supportive & Palliative Care (2004)

  4. Manual for Cancer Services (2008)Rehabilitation Measures: • no. 08-1E-101v:Baseline Mapping of current service provision • no.08- 1E103v: Agreed cancer site specific rehabilitation pathway for patients with lung cancer • no.08-1E-113v:Network service specification for cancer rehabilitation • no.08-1E-114v:Network needs assessment • no.08-1E-115v:Network Service development strategy • no.08-1E-116v:Network cancer rehabilitation training & development strategy

  5. National Cancer & Palliative Care Rehabilitation Workforce Project: • Commenced November 2007 • Jointly funded by DH & Cancer Action Team • Focus on rehabilitation services provided by AHP’s: • Physiotherapists • Occupational Therapists • Dietitians • Speech & Language Therapists

  6. National Cancer & Palliative Care Rehabilitation Workforce Project: Deliverables: • updated tumour specific evidence base • published tumour specific rehabilitation pathways • quantify level of cancer rehabilitation required: wte per cancer site population • provide workforce data to support network cancer populations

  7. Why do we need a lung cancer rehabilitation pathway? • Effectiveness of rehabilitation services in other conditions is well established i.e. stroke, cardiac & pulmonary care • Increased recognition of need for rehabilitation in cancer care (Supportive & Palliative Care IOG ch10 / Cancer Reform Strategy ch5 / National Cancer Survivorship Initiative)

  8. Why do we need a lung cancer rehabilitation pathway? • cancer & its treatments impact on patients physical, psychological, social & functional well-being • helps patients maximise the benefits of their cancer treatment • minimise deconditioning/loss of function • Adaptation of ADL and routines to new needs and limitations • improve social condition, quality of life

  9. Why do we need a lung cancer rehabilitation pathway? • evidence based interventions available • non-pharmacological symptom control • Multi-professional breathlessness management(Lung Cancer Clinical Guideline 24) • supports recovery of skills, return to previous work/ roles • cost effective: reduce utilisation of other healthcare resources, decrease hospital length of stay and hospital admissions

  10. Breathing difficulties/cough Fatigue/tiredness ↓ mobility/exercise tolerance/weakness Pain Cachexia/weight loss ↓ Appetite Dysphagia Difficulties with ADL/leisure/work Specific functional impairment Equipment needs Anxiety/stress Communication difficulties Specific Information needs Patients with Lung Cancer may experience the following at any point on the pathway:

  11. Rehabilitation pathway referral triggers:

  12. Rehabilitation pathway referral triggers:

  13. Diagnosis • Maintain exercise tolerance/ function • Nutritional support • Breathlessness/pain/fatigue management Treatment • Maintain exercise tolerance/ function • Nutritional support • Breathlessness/pain/fatigue management Post treatment • Maintain exercise tolerance/ function • Nutritional support • Breathlessness/pain/fatigue management Monitoring Survivorship • Maintain exercise tolerance/function • Vocational rehabilitation Rehabilitation in LungCancer Palliative Care • Breathlessness/pain/fatigue management • Maximise functional independence • Nutritional support • Advanced care planning End of Life • Advanced care planning • Equipment provision • Non-pharmacological symptom management

  14. How are rehabilitation needs of Lung Cancer patients identified in MCCN? • No formal assessment tool currently in place • Medical/CNS led clinics • District Nurses/Community CNS • Currently, rehab services mostly in hospices • Rehab needs may be present before symptoms prompt referral to hospice

  15. Rehabilitation Services for patients with lung cancer in MCCN. • Most in-patient & community rehabilitation provided by generic AHP’s • Little planned/ funded specialist cancer rehabilitation outside specialist trusts, hospice & palliative care services • Gaps in service for ambulant patients who are not referred to palliative care • Some generic staff have post graduate training in oncology & palliative care

  16. Funded specialist rehabilitation services for patients with lung cancer in MCCN

  17. Challenges: • Despite improvements in treatment outcomes for lung cancer patients • relatively little increase in rehabilitation support to mitigate functional loss • no evidence of rehabilitation services being specifically commissioned as part of the cancer care package.

  18. Challenges for commissioners and providers in MCCN: • rehabilitation not strongly articulated in commissioning process • cancer pathways medically focused • rehabilitation not described in Lung Cancer IOG • lack of understanding of the broad nature of cancer rehabilitation interventions

  19. Challenges for commissioners and providers in MCCN: • cancer- a ‘long term condition’, ‘end of life care’ or both? • variable models of service delivery • performance monitoring, quality metrics, KPI’s and outcome measures • funding priorities • NCAT Commissioning Framework for rehabilitation services

  20. High quality cancer rehabilitation in MCCN needs to be: • Timely & responsive • Generic & specialist AHP’s are accessible • Seamless across service boundaries • Delivered in appropriate setting • Focus on prevention & management of long term effects

  21. Network Lead AHP & Rehabilitation Group responsibilities: • Consult with local AHP providers, Lung CNG, Lung CNS & Partnership Group • Facilitate local implementation of lung cancer pathway • Clear referral guidance and processes • Directory of Cancer Rehabilitation Services • Patient Information Leaflets • New developments i.e. MPT follow up clinics • Education& Training • Audit

  22. Thank you • http://www.cancer.nhs.uk/rehabilitation/index.htm • Jo Bayly joanne.bayly@aintree.nhs.uk 0151 529 2299