Suggestions for Early Cancer Diagnosis DES
Suspected Cancer Referrals – Updated NICE Guidelines
Nice have recently updated the suspected cancer referral guidelines. The full guideline can be accessed at http://www.nice.org.uk/guidance/NG12
Macmillan have summarized these for ease – Rapidreferralguidelines.pdf
Mobile and tablet friendly versions are also available here – Early diagnosis programme
New national standard referral proformas are currently under development to reflect the changes in the updated guidelines and will be available on this website as soon as they are released. In the meantime, please use the current suspected cancer proformas which can be accessed by clicking here, but clearly indicate in the history box any referral that does not fit the old criteria but is in line with the new guidelines.
It is important that all patients referred down the Suspected Cancer referral route have a potential cancer diagnosis discussed at the time of referral and are given a copy of the Suspected Cancer referral leaflet which you can access using the link below. This helps to reduce patient DNA’s/ cancellations and allows patients the opportunity to be potentially prepared for bad news and take a companion for support.
Suspected Cancer Proformas – click here to access
Cancer Access and Validation Policy
A new GM wide cancer access and validation policy has now been published. This sets out the responsibilities of the referrer, patient and secondary care when managing suspected cancer referrals, clarifying what is a reasonable offer of an appointment etc and under which circumstances a patient may be discharged back to the GP due to lack of engagement or repeated DNA’s.
Patient Information Leaflet
(please remember when printing this leaflet to print double sided and to select flip “up” rather than flip “over”. These choices can be found under the “properties” button when you select print.Sarcoma and Bone Cancer Referral Guidelines
There has been some confusion regarding the correct referral pathway for these rare tumours. Click on the link below for up to date guidance.
Unsuspected Cancer Pathway and Cancers of Unknown Primary
There has previously been some confusion over the unsuspected cancer pathway; who does what and who takes responsibility for each action. The pathway has now been redesigned to provide better clarity to GP’s. The forms used for notifying GP’s of an unsuspected cancer have been adapted to reflect this.
When it is possible to identify a primary site for the cancer, patients will automatically be referred into the appropriate MDT meeting by the reporting radiologist, although GP’s will still be responsible for discussing the possible cancer diagnosis with the patient and providing a patient history and background information to aid discussion at the MDT. Where further investigation or treatment is felt inappropriate by the GP, it is possible to remove a patient from this pathway.
When it is not possible to identify a primary site, the reporting radiologist is not able to refer the patient into a specific MDT. However, the oncologists have now provided some guidance to aid GP’s in making decisions with regard to future management of these patients. Once finalised, this guidance will shortly be published on this website.
Acute Oncology Service Update
The Acute Oncology Service at Stepping Hill Hospital is led by Dr Catherine Coyle, Consultant Oncologist from The Christie. She is supported by other visiting Christie Consultants, and between them they provide support for the Acute Oncology Service from Monday to Friday. The aim is to provide a dedicated service for patients who present urgently with cancer-disease or cancer-treatment related problems. Some of these patients will be suffering the effects of an undiagnosed cancer.
Christine Griffiths, Acute Oncology Advanced Nurse Practitioner, is an experienced cancer nurse who works alongside the A&E Department and the Acute Medical Unit, assessing cancer patients and advising medical teams on management of cancer related problems. The aim is to speed up investigation, symptom control and patient review by cancer specialists.
Contact details: Christine Griffiths, Acute Oncology ANP – Mon to Fri (0161 483 1010 on Bleep 1116)
For assistance with patients, please send patient sensitive information to:snt-tr.stockportaos@nhs.net
- Alternatively, information is available 24/7 via the Christie Hotline – 0161 446 3658 or via the St Ann’s 24 hour advice line – 0800 970 7970
Lymphoedema service
The Christie lymphoedema service has expanded and:
- The Christie accepts referrals for people with cancer related lymphoedema who are not Christie patients on our main site. Patients with mild to severe lymphoedema involving more than 1 limb or midline will be accepted at The Christie.
- There is a satellite site based at the Beechwood Cancer Care Centre. Satellite clinics are keyworker led, so will only be open to people with mild to moderate lymphoedema in 1 limb.
End of Life Care Guidance
Local guidelines have been developed and endorsed by the Strategic Clinical Network and is now available. The emphasis is on clinicians, evaluating, discussing and documenting rather than ticking boxes. It is based around principles of care namely;
- The possibility of death in the next days or hours is recognised and communicated. Decisions made and actions taken are in accordance with the person’s needs and wishes, and are regularly reviewed and decisions revised accordingly
- Sensitive communication between staff, the dying person and those important to them
- The dying person, and those identified as important to them, are involved in decisions about treatment and care to the extent that the dying person wants.
- The needs of families and others identified as important to the dying person are actively explored, respected and met as far as possible.
- An individual plan of care, which includes food and drink, symptom control and psychological, social and spiritual support, is agreed, coordinated and delivered with compassion.
There are also algorithms for drugs and suggested dosages that may be helpful for symptom management in such patients.
One of the key learning points is that clinicians involved in EOLC should be adequately trained and competent. There is no clear consensus at present as to what constitutes adequate training, but one element that is likely to be a consideration is communication skills training.
- Last Days of Life Algorythms (2019)
- Individual Plan of Care and Support for the Dying Person Review 2018
Community DNACPR Policy
Although a DNACPR policy has been in place in secondary care for some time, it is now being rolled out into the community. It is hoped that this will help avoid unnecessary distress caused by futile resuscitation attempts and will encourage good communication between clinicians, patients and their carers/ relatives. It is recommended that all primary care clinicians have training around this new policy.
Resuscitation Council Updated guidance can be accessed via:
https://www.resus.org.uk/EasySiteWeb/GatewayLink.aspx?alId=838
For further information or guidance, please contact the palliative care team.
GP Education and Courses
GP’s may be interested in the following courses:
- GP-Update – A one day update course covering current guidelines and new developments in cancer care. Various locations in UK, including Manchester. Price – £195. Book online at www.gp-update.co.uk
- Enhanced Communication Skills Course – an excellent 2 day course run by the palliative care team, aimed at increasing clinician confidence in having difficult conversations, particularly around palliative care issues but also more widely in day to day practice. For more information or to apply contact – kirsty.ince@nhs.net Tel: 0161 426 5266
CRUK Health Professional Engagement Facilitator – Steve Jones
Cancer Research UK (CRUK) is partnering with the NHS and Clinical Commissioning Groups to help improve early diagnosis and cancer outcomes in primary care by providing intensive support in several regions.
The aims of the programme are to:
- Raise awareness of the importance of early diagnosis
- Reduce the time from first presentation of symptoms to a cancer diagnosis
- Improve 2 week wait referral ratios, conversion and detection rates
- Increase use of the six diagnostic tests outlined in the Improving Outcomes for Cancer Strategy (IOCS)
- Increase the proportion of cancers diagnosed at stages 1 and 2
- Increase engagement between primary and secondary care
Steve Jones is the facilitator working across Stockport, Salford and Trafford CCGs. Steve will be working with the CCG to tailor the offer based on local need and plans, and over the course of the next few months will be contacting GP practices to offer his support.
- HPE Facilitators are there to provide tailored support to suit practices’ specific needs in agreement with each practice. Examples of support that can be provided include:
- Providing practice level cancer data and interpretation
- Support practices to reflect on previous cancer cases and make sustainable changes
- Sharing best practice and innovative solutions from other practices / regions
- Offering training to clinical and non-clinical staff
- Support to utilise a range of tools such as RCGP audit, risk assessment tools, significant event analysis and safety netting guidelines
- Providing evidence, information and resources to help practices with specific issues
- Providing resources and support to implement initiatives to encourage uptake of the national screening programmes
- For further information, you can read more detail here on the CRUK website:
Information for Patients and Families
Cancer Survivorship – Health and Wellbeing
There is increasing emphasis on “cancer survivorship”, supporting patients throughout their cancer journey. As part of this work, we are developing “health and wellbeing events” aimed at patients who have finished their primary cancer treatment, aimed at encouraging patients to regain as much health and quality of life as possible, empowering them to make positive lifestyle changes and providing advice on symptom control.
The Macmillan website (www.macmillan.org.uk) has a wealth of useful information on all aspects of cancer care from screening, investigations, treatment, patient support, benefits and work issues for patients and clinicians.
St Ann’s Day Therapy Drop- in Service: Mondays 9am – 6pm (exc Bank Holidays)
St Ann’s Hospice has launched a drop in service at the Heald Green site. This regular, informal drop-in day aims to offer specialist advice and support for people living with, or affected by, life-limiting illnesses. It is open to patients, as well as their families and carers (who can attend independently), regardless of where they live, are being treated or whether they have been to St Ann’s before. An initial assessment will help identify individual’s needs and requirements, they will then be able to access services such as physiotherapy, counselling, complementary and creative therapies, as well as spiritual and peer support. See leaflet below.
To find out more about the service – contact Del Wray (project lead) – 0161 498 3611. dwray@sah.org.uk
Manchester Cancer – User Involvement Group
The Macmillan User Involvement team at Manchester Cancer are looking to recruit people who have been affected by cancer to help improve cancer services across Greater Manchester and East Cheshire. By sharing experiences and opinions, current and former patients, their family and carers, will shape cancer services and ensure that care is patient focused and patient centred.
To get involved, or if you have any questions, please call us on 0161 918 2368, or email mc.userinvolvement@nhs.net. You can write to us, at Macmillan User Involvement Team, Manchester Cancer, c/o The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, M20 4BX.
www.manchestercancer.org/user-involvement-2/
Below is a link to a poster that can be displayed to help recruit patients:
Macmillan Active Manchester
This group is based at the Beechwood Cancer Care Centre. As it sounds it is aimed at increasing activity levels in cancer patients, as well as providing peer support.
For further information or to enrol, contact Beechwood on 0161 476 0384 or enquiries@beechwoodcancercare.co.uk
Benefits Advice – David Banks (Macmillan Welfare Rights Officer)
Most GP’s will have been asked at some point to complete a DS1500 for a patient, or have been asked for benefits advice. David Banks can give advice to patients or clinicians with regard to what benefits are available and appropriate. He can be contacted via David.Banks@stockport.gov.uk
Tel – 0161 218 1300 – mobile 07800 617 797
The link below is to the most up to date guidance regarding completion of DS1500 –
Local Cancer Lead Contacts
Dr Andy Johnson, GP Cancer Lead – andrew.johnson6@nhs.net
Dr Karen McEwan, Macmillan GP Cancer Care Commissioning Lead – karenmcewan@nhs.net
If you have any comments or suggestions on cancer care in Stockport or regarding the cancer information on this website please contact Dr Karen McEwan via email using the link above.