Secondary care perspective

Winter 2012

Part two of Sharing good practice, by Dr Alaistair Smith, Honorary Consultant Haematologist and Clinical Adviser for Macmillan Cancer Support. 

Progress has been made to develop a Treatment Summary that formalises information about treatment and future care for people after cancer treatment. However, until recently, there has been little systematic approach to understanding the care needs and pathways of this group.

People with cancer undergo follow up - a medically-driven process aimed at measuring the presence, progress or absence of cancer.

As people with cancer live longer, and survival rates increase, this process isn’t sustainable and fails to meet the needs of many people living with and beyond cancer. There is now a general consensus that a structured HNA is essential to planning care after treatment.

But there remains vagueness as to how it’s done and who is responsible. Logically, HNA should inform the Treatment Summary. The Treatment Summary provides valuable, practical information that facilitates future healthcare planning and helps identify problems that may need urgent re-referral.

The challenge now is to achieve consistent, secondary care engagement in the process of producing a Treatment Summary and HNA. Introduction of HNA should not represent extra work; rather it needs to be seen as supporting clinical care and potentially reducing the burden on secondary care.

An alternative way of looking at HNA is that it revisits the initial clinical and ‘social history’, and allows the patient and clinician to identify what may have changed and what can be the same again. 

The process is forward-looking – it doesn’t require the secondary care team to provide all the answers. It’s about recognising issues and how these might be addressed. And not all issues can or should be addressed within NHS provision. There are simple questionnaires that patients can complete to highlight their issues. These can be filled out prior to the appointment, online or in the waiting room. The information obtained should make the clinic consultation more effective and add value to the Treatment Summary. If done well, the ability to understand and act on the information from the assessment will reduce subsequent health service dependency.

Achieving the necessary process and cultural changes in secondary care to facilitate simple, structured, post-treatment HNA is fundamental to improving cancer survivorship and the sustainability of services. With some simple changes to clinics and the use of HNA tools, secondary care can make a big difference to the quality of people’s lives after cancer treatment. Measuring the presence or absence of cancer in an individual after treatment clearly remains important, but the outcome of this must be put in personal and clinical context to support the individual to maximise their quality of life and achieve their goals.

About the author

Alastair has over 28 years experience as a consultant haematologist, with an emphasis on management of myeloma, leukaemia, and related haematological cancers. Email Dr Alastair Smith|.

Treatment summary

A Treatment Summary| is a document produced by secondary cancer care professionals at the end of a person’s treatment. It provides GPs with important information including, possible treatment toxicities, side effects and/or consequences of treatment, signs and symptoms of recurrence and any actions for the GP.

Continue reading Sharing good practice

Back to part one -  Holistic needs assessment and care planning|

Part three - Test site perspective|

Louise Smith, Cancer Information Specialist and Centre Manager and Ipswich Project Lead for Survivorship.

Part four - Evidence base|

Anne Wilkinson, National Improvement Lead, NHS Improvement.

Part five - Policy|

Relevant policy documents.

Part six - Resources|

Relevant resources.

Part seven - References|

References for this Sharing good practice.