Background The best of palliative medicine and care is underpinned by multi-professional working to optimise symptom management and quality of life once disease specific treatments are no longer appropriate. However, physical and emotional issues are common much earlier in the disease trajectory, during diagnosis and challenging treatments, but aren’t always addressed as vigorously as later. The concept of Enhanced Supportive Care is to change this, offering the benefits of good palliative care and medicine alongside active anti-cancer treatments. There’s international evidence that this can lead to improved symptom management, quality of life and survival. Thus, NHS England is championing a national pilot, of which we’re part, offering ALL patients receiving systemic anti-cancer therapies with palliative intent referral to the ESC team.
Method Discussions with oncologists, palliative care teams, cancer site specific nurses and chemotherapy team, explaining the background and concept. Working closely with oncology IT team designing electronic referral and data collection pathways. Team development – initially a palliative care and oncology trained nurse supported by a palliative oncology consultant, later adding a GP.
‘Tools’- King’s Fund Patient Outcome Score (IPOS) – primary tool and Hospital Anxiety and Depression Score (HADS).
Changing mind-sets promoting PRO-active rather than RE-active referrals.
Results Rising referrals – 35 in February, 72 in November. Reduction of scores (improvements) in all domains of IPOS, other than nausea and fatigue, improved quality of life and avoided admissions.
Conclusion and future Introducing this new service has been challenging and exciting, involving broadening the ‘multi-disciplinary team’concept, diplomacy, tact and collaborative working, promoting our skills as an additional benefit, not in competition with other professionals, focusing on the patients quality of life. Our long-term goal is remit expansion to all patients receiving anti-cancer therapies, irrespective of disease stage and treatment intent.