The Treatment Summary

A Survivorship Tool in Primary Care

Terry Bowley Macmillan GP Advisor North Central, North East

London & Sussex, GP in Redbridge

GP Advisers (GPA)

• Based across the UK

• Work closely with Macmillan to enhance care for those affected by cancer in the primary care area

• Provide strategic leadership for primary care to Macmillan

• Help support the development of the primary care workforce as regards delivery of Macmillan strategies

The cancer story is changing

Cancer as a long term condition

Macmillan’s Priorities

I was diagnosed earlyI understand, so I

make good decisions

I get the treatment and

care which are best for

my cancer, and my life

Those around me are

well supported to help

me, and themselves

I am treated with

dignity and respect

I know what I can do

to help myself and

who else can help me

I can enjoy life

I feel part of a

community and I’m

inspired to give

something back

I want to die well

By 2030, the 4 million people living with cancer in the UK will say:

What do patients need after Primary treatment?

• A long term supportive professional relationship.

• Help with symptoms and side effects of disease and its treatments.

• Information to enable self management

• Rapid referral back to specialists as needed.

• Signposting to others who can help.

Cancer “survivors”.

• Over 40% may have long term effects from the cancer and treatments1 • Many have unreported emotional and physical problems1

• Will have poorer health outcomes in the presence of co-morbidities • Will use GP appointments more than age matched controls2 • This increased demand varies between cancers but prostate cancer patients

may consult three extra times per year for >15 years.3 • May not identify primary care as best placed to deliver long term cancer care,

due to three barriers. GPs being perceived as “non-expert”, as “too busy” and the lack of “continuity of care” in general practice making discussion of long term issues difficult.4

• Many are going to find themselves followed up within Primary care soon.

1-Macmillan Health and Wellbeing of Cancer Survivors Study 2008 2-Armes et al J Clin Oncol. 2009 Dec 20;27(36):6172-9. Epub 2009 Nov 2.Patients' supportive care needs beyond the end of cancer treatment: a

prospective, longitudinal survey. 3-Khan et al Br J Gen Pract. 2011 March 1; 61(584): 197–199 4- Khan et al Br J Cancer. 2011 Nov 8;105 Suppl 1:S46-51. doi: 10.1038/bjc.2011.422

What is a Treatment Summary?

Produced by Secondary Cancer Care Professionals At the end of initial treatment for cancer and other

subsequent trigger points Shared with patient and their General Practitioner Outlines treatment that has been received, side effects, signs

and symptoms of recurrence Enables GP database to be kept up to date including cancer

care review (CCR)

Why was it developed?

Increasing numbers of survivors, summary details varied between hospitals (what follow up is required? who is responsible, possible post treatment long term effects)

2009 – Macmillan GP Advisors identified information

that would be helpful at the end of initial treatment TS Template was designed to capture this information 2010–2012 – TS tested in 11 NHS test sites across several

tumour groups

Who it is aimed at?

GPs and Primary Care professionals Patients - record for visits to

GP/hospital (travel insurance) Secondary Care Clinicians, particularly

for A & E and any unplanned emergency admissions

Hospices & Care Homes

Summary of evaluation findings

• Positively received in both primary and secondary care

• 80% of GPs found summary useful or very useful

• Over 50% felt that it would make a difference to the way they manage patients

• 90% wanted its use to continue

• The majority of hospital clinicians recognised the value of summarising what could be months of treatment/care in to a concise summary

Style and Format

3 different formats – a template (GP read codes attached) a structured letter, electronic template www.ncsi.org.uk

Electronic template can be automatically populated from the Cancer Information Systems (CIS) provided by Somerset Cancer Register & Infoflex. This can be added to the patient’s electronic record – quicker and easier to complete

The Treatment Summary

London Cancer

• Made the decision to implement the Macmillan template locally

• Aim is to embed it in the Urology pathway initially

• Aim to roll out to other pathways next year

National Cancer Survivorship Initiative Website www.ncsi.org.uk

(Assessment & Care Planning)

Acknowledgements:

Noeline Young Project Manager NCSI Anne Wilkinson National Improvement Lead – Cancer GPA Group Nicola Harker MacGP Weston Super Mare David Plume GPA (Anglia) Helen Rickard Healthcare Project Officer, Primary & Community Care Macmillan