Living with & Beyond Adult Cancer: What has been achieved so far? Adam Glaser

1. Living with & Beyond Adult Cancer: What has been achieved so far? Adam Glaser National Clinical Lead National Cancer Survivorship Initiative

2. Adult Cancer Survivorship • Where were we 3 years ago? • Where are we now? • What do we need to do next?

3. 3 years ago • Lack of clear evidence • Needs • Practice • Variation in practice • Overwhelmed services • Unmet needs • Poorly quantified • Disparate and sceptical clinical teams

4. Process • Identified 4 tumour sites • Breast, colorectal, lung, prostate • Robust service improvement methodologies • Expert panels • Pathway mapping • Pilot testing • Partnerships • DH & NHS Improvement • Macmillan Cancer Support and disease specific charities • Service Users, Providers and Commissioners

5. Testing Hypothesis – The introduction of stratified pathways and packages of care will improve the patient experience, reduce outpatient attendances and reduce unplanned admissions

8. Risk Stratification - Headlines • Pathways – Breast and Prostate – 2 pathways only • Supported self management • Colorectal – 45% (40%) • Breast – 77% (70%) • Prostate – 28% to 44%(40%) • Lung – some can self manage for periods • Timing • Breast 2-3 months after end of treatment or one year after diagnosis • Prostate could happen at 6 months but most at around 2 year point • Colorectal – 4-6 months after end of treatment or stoma reversal • Lung – n/a • Clinical trials – impact on % that can transfer to self managed

9. Key enablers • Comprehensive assessment holistic needs • end of treatment or at agreeable point in pathway • Remote monitoring system • Personalised education and information • Care co-ordination and contact point • Preferably someone they know • Rapid re-access without recourse to GP

10. Remote Monitoring – we are getting there! • Breast (5 sites) • local solutions all live • 2. Colorectal (3 sites) • NHS Improvement solution - Bristol • goes live 1st April • In house solutions - Guys and Salford • currently testing with go live April/May • 3. Prostate (6 sites) • NHS Improvement solution – all sites • 2 sites live, 2 testing and 2 installing

11. Enhanced Quality Drives up Productivity • Reduced OP activity 4,985 outpatient slots released across 14 tumour teams • Reduced OP costs £349,000 reduction in cost of OPD attendances Health warning: Needs to be offset against cost of implementing pathway enablers • Reduction in unplanned admissions 6-8% in lung cancer

12. What do we need to do next? • Develop and Spread pathways and learning • Whole country • Apply key learning and messages to other tumour sites • Work with the health economy • Education • Service users, commissioners and providers • Evidence • Safety and impact of risk stratified pathways • Consequences of treatment • Incorporate all strands of evidence into applied deliverable pathways

13. Summary • Huge progress but job not complete • Simplified common pathways, providing a framework to further build and develop evidence-based sustainable care pathways • Reduction in unmet needs and enhanced productivity • Not possible without the engagement, enthusiasm, passion and dogged determination of all members of our new “Survivorship Community”.