Cancer Screening: Benefits and Risks

1. CANCER HEALTH & WELLBEING To deliver and maintain evidence based health and wellness to those affected with cancer. KLH / HMG MAY 2018

2. NHS Screening • APPROACH TO SCREENING: Making an informed choice, find out about the test and what the next steps would be if you were to be at risk. You can discuss screening with your Doctor or Nurse. • BENEFITS: Early detection before any symptoms meaning treatment can be more effective. Finding you have an increased risk can help make better informed decisions about your health. KLH / HMG MAY 2018

3. TYPES OF SCREENING: The NSC (Nation Screening Committee) is an independent group that advises the NHS on which programmes to offer. Current Cancer screening programmes in England include: • Breast: offered to women aged 50-70 to detect early signs of breast cancer. Women >70 can self-refer • Cervical: offered to women aged 25-64 to check the health of cells in the cervix. Screening is every 3 years >49years and every 5 years 50+. • Bowel: 2 Types of screening: home testing offered to men and women aged 60-74. bowel scope offered to men and women >55years in some parts of England. KLH / HMG MAY 2018

4. BENEFITS RISKS AND LIMITATIONS • Screening can reduce risk of developing condition or complications • Can save lives • Not 100% accurate • False positives/negatives • Difficult decisions • Normal/negative does not mean you could not go on to develop the condition in the future KLH / HMG MAY 2018

5. SCREENING in GP • Through a collaboration with CRUK and SCCG we met with representative to discuss figures and how we can ensure our “cancer care activity” is operating at the highest level. • Following this we created an action planmeeting and surpassing all milestones and still finding ways to improve. KLH / HMG MAY 2018

6. Our Plan in Action:Tagging codes and benefits • TAGGING CODES: In our clinical system (EMIS WEB) when we refer a patient for a suspected cancer we use a certain “code” which is recommended however as a safety net we tag on a diary entry follow up code to “catch” these patients that have been referred. We run the codes every week and use this to check that: • 1. The patient has been seen • 2. Paperwork has been received from the hospital • 3. If there is a delay in any of 1 or 2 to chase KLH / HMG MAY 2018

7. If the patient has attended their appointment their details are added to our 2wr file to await the outcome of the appointment. The file is checked weekly. Correspondence received is documented and the details from the file are input onto the patient record. The benefits are that patients are being followed up whether they cancel/rearrange their appointment or DNA due to some other issues. • Our NICE symptom referral guidance was modified where the clinical information was transferred into an easy read colour coded key and in all clinical rooms. One step further still, we made links to the online CRUK symptom checker in all our templates so all clinicians not only doctors can highlight and take action. KLH / HMG MAY 2018

8. Staff involvement • It is important for all staff to be aware of referrals / diagnosis to give patients priority access if required. Those with a cancer diagnosis have a FLAG ALERT on their records. The admin team are also more responsive and able to flag any patients to relevant clinicians who they feel are deteriorating. KLH / HMG MAY 2018

9. Why keep logs • ALL our 2wr referrals are logged onto spreadsheets enabling us to track referral outcomes, chase up anything missed from the previous process and look for patterns in symptoms and timeframes from presentation of first symptoms to referral and is discussed at clinical meetings. We have noticed a significant rise in upper and lower GI (Stomach and Bowel) referrals and use this information to heavily promote healthy wellbeing and lifestyles into our chronic disease management programmes. KLH / HMG MAY 2018

10. Why did we adapt our templates • We adapted our COPD and Smear templates to add in chest xray referrals and the 2wr referral pathway so practice nurses have a snapshot of “redflags” to initiate and raise with the GP. Although health and wellbeing are included in most templates, through our data collection we really push this aspect in our chronic disease management and routine patient reviews. KLH / HMG MAY 2018

11. Health and wellbeing promotion • Promoting health wellbeing and lifestyle: • Stopping Smoking if you smoke • Gradually being more active to help recovery and long term health • Eating healthily to help you feel better and keep to a healthy weight • Sticking to sensible drinking guidelines to look after your overall health • Finding helpful ways to reduce stress, such as doing things you enjoy with family / friends. KLH / HMG MAY 2018

12. DNA SCREENING • We treat breast bowel and cervical screening the same. The initial invite is via the NHS Screening Programme. If a patient fails to attend we are notified and have a process that starts the follow up system. Once coded as a DNA, we send a 2nd invite letter with the screening centres details included and have a diary in the background which places a further reminder in the patient record. After another month we check the diary and either send another letter or ask one of our clinicians to call the patient to ask why the patient has not taken up this screening opportunity. We send 1 further letter after another 4 weeks as reminder and contact the patient to record their refusal on the records. KLH / HMG MAY 2018

13. FUTURE OF Cancer Care Reviews • At present there is a system for those with a cancer of a history of cancer to have a cancer care review (within 6m of diagnosis and annually thereafter) – this is anything from how are you doing to a full MOT, there is currently no definitive template or quality set for this. This is something myself and other CCG and Primary Care clinicians are looking to raise in the very near future. KLH / HMG MAY 2018

14. We wish to have a standardised template to use to capture information about their specific cancer and what to look for in future and how living with/surviving cancer can be treat the same as any other long term conditions such as diabetes; giving patients a chance to think through their needs, issues, symptoms, and together with their healthcare professional make a plan about how to best meet these needs. KLH / HMG MAY 2018

15. By mirroring our chronic disease templates this will allow the clinicians to keep track of different elements of a patient’s recovery, enabling the quick capturing of information about an individual that is relevant and important to them and means the clinicians seeing the patient will have that information at hand to maximise the care/support given to the patient. The template would also have clear sections such as “treatment consequences” and “psychological impact” where clinicians can effectively screen for anxiety and depression, thereby making sure no aspect of the person’s wellbeing is missed. Ideally the template would have a check list of common symptoms that may occur either during of after cancer recovery to enable provision of timely rehabilitation and support. KLH / HMG MAY 2018

16. This care plan would be a clear list of actions for the patient to follow allowing them to be in control of their recovery. • References: • Kelly Hardy, Hylton Medical Group • London Cancer.org • Macmillan • CRUK KLH / HMG MAY 2018