Acute Oncology Service (AOS)Monday – Friday

8am – 4pm

Bleep: 946

T: 020 8401 3000 x5726

F: 020 8401 3513

Dr Nicola BeechDr Jillian NobleDr Susannah StanwayMiss Robyn Jenkins

Advanced Nurse Practitioner (AOS Lead)Consultant OncologistConsultant OncologistAOS Administrator

Croydon Healthcare Services

• Population of 346,000• 65 years and over (13.8%)• 85 years and over (1.9%)• 61 GP practices• Croydon University Hospital 572 beds• Member London Cancer Alliance

Disease sites•Lung•Upper GI•Lower GI•Breast•Gynaecology•Urology•Skin•Haematology

Diagnostics

Cancer MDM Treatment

Palliative care

Cancer MDM

2013 JAN FEB MAR APR MAY JUN JULY AUG SEP OCT NOV DEC TOTALS

Number of referrals

46 45 67 64 57 38 53 48 66 33 41 66 624

Known primary site

26 34 44 43 40 28 25 28 34 28 22 43 395

Suspected 20 11 23 21 17 10 28 20 32 5 19 23 229

Known Cancer Centre

26 33 36 36 32 20 21 24 30 24 17 41 340

RMH 23 27 32 26 28 19 19 20 28 6 14 33 275

OTHER 3 6 4 10 4 1 2 4 2 18 3 8 65

AOS referrals

GP referrals

• 61 GP practices• 6786 urgent referrals suspected cancer (2012/

2013)• Conversion rate 9.82 (4th highest LCA)• 1678 new cancer registrations (2011)

AOS ULCN Pathway V1 30.04.2014

ULCN Received via fax/ AOS nhs.net inbox

Review report and patient clinical records

Confirm patient has been put on a pathway

Fax report to GP if not under any team/ pathway

Monitor as part of audit for diagnostics, confirmed diagnosis and treatment

Assess to see if any AOS input is required

If AOS input required, review on ward

No AOS input required, patient being

appropriately managed

Monitor as part of audit for diagnostics, confirmed diagnosis and treatment

Discharge from AOS once AOS are happy with management

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INPATIENT OUTPATIENT

MUO CNS

• To provide support and information to patient • To improve coordination of diagnostic

pathway• To speed time to diagnosis• Source of expertise for GPs and colleagues

Consultant Oncologist Job plan

• Started in the Trust in November 2012• Joined in December 2012 by Dr Jill Noble• Work between RMH (Breast Unit) and CUH

(Acute Oncology Service and Breast Unit)• RMH employed- similar consultant posts at

Kingston Hospital and Epsom and St Helier

What we can offer

• Cancer expertise– Diagnostics– Treatment complications– Disease complications

• Liaison with Cancer Center where necessary

Job planMonday Tuesday Wednesday Thursday Friday

Acute Oncology

CUP MDT

Acute Oncology Breast Clinic RMH

Breast Research MeetingAcute Oncology

RMH Breast Academic meetingAcute Oncology

Acute Oncology SPA Breast Clinic RMH

Breast MDT CUH/RMH

Breast Clinic CUH/SPA RMH

SPA

Our aims • Earlier diagnosis• Correct management quicker• Shorter inpatient stays• Ambulatory pathways• Closer to home• Referral to cancer center where

necessary• Referral to palliative care where

appropriate• IMPROVED PATIENT EXPERIENCE

• EducationPatientStaff-hospital and community

• ResearchCADIAS

Case Study 1

• 55 year old lady• History of breast cancer• Presents with nausea and vomiting

Results:•Calcium level is elevated at 3•Imaging show she has new bone and liver metastases (secondary breast cancer)

Treatment:•IV fluids and bisphosphonates•Biopsy to confirm metastatic cancer•Referral to RMH for ongoing outpatient management

Case Study 2• 70 year old man• Admitted with a cough and a swollen face

Results:•CXR - widened mediastinum•CT - lung mass, enlarged lymph nodes obstructing superior vena cava

Treatment•High dose steroids to reduce swelling•Referred to respiratory for stenting•Discussion at CUH MDT (video-linked to RMH) •Offered radiotherapy

Case Study 3• 22 year old man• Admitted with back ache

Investigations•Examination and blood tests reveal no abnormalities•CT scan - large retroperitoneal mass

Differential diagnoses include sarcoma, lymphoma, germ cell tumour (amongst others)

Treatment•His imaging is IEPed to RMH to be discussed at the sarcoma meeting•He is transferred as an inpatient to have surgery

Future developments

• Ambulatory care facility to avoid admission• Outpatient clinic• Trust wide dissemination protocols and

pathways• Trust wide education programme• Joint teaching with CUH and RMH