Thursday 20th June 2013
Sue Acreman (formerly Chair of the National Cancer Rehabilitation Advisory Board, now retired) on the Cancer and Palliative Care Rehabilitation Workforce Advisory Group.
The Cancer and Palliative Care Rehabilitation Workforce Advisory Group was convened to evaluate the contribution made by specific Allied Health Professionals (AHP) to cancer care pathways. The AHP groups for consideration were physiotherapists, occupational therapists, dietitians and speech and language therapists.
The group met from 2007 to 2010 and addressed a range of issues. These included the production of clinical pathways and a workforce data model, both of which needed underpinning evidence showing the effectiveness of AHP interventions. This preliminary work led to subsequent commissioning of a review, originally published in 2009. This piece of work covered eight tumour sites and 11 symptoms, and was updated in 2012 to include three new tumour sites.
Methods of gathering information included locating studies through databases and working with experts in the field. These methods were designed to be as transparent as possible and provide a broad overview of the evidence. However, the 2009 review looked only at randomised control trials, non-randomised control trials and systematic reviews. As such, there was a large volume of peer reviewed evidence that deserved a ‘second look’.
It is accepted that there needs to be much greater emphasis on formalised research, such as the research included in the two reviews from 2009 and 2012 and it is heartening to note the increase in this type of research between the two published reviews.
Considering the evidence
Professional bodies representing dietetics, occupational therapy, physiotherapy and speech and language therapy nominated working groups to provide consensus on what evidence to include. This was then ratified by expert reference groups from the professions.
Each professional working group looked at a range of papers and considered whether the evidence filled any gaps in the two existing reviews, and whether it was ‘good enough’ to be included. Particular attention was paid to palliative and end of life care, as the 2009 and 2012 reviews provided little or no evidence in these areas. Much of the evidence was deemed acceptable for inclusion in the pathways. The two published reviews provided a variety of evidence to justify a range of clinical interventions, and a consensus document will be available in the near future.
Filling in the gaps
The project’s aims were to furnish the pathways with evidence and provide a steer for AHPs and other members of multidisciplinary teams who may care for people with cancer in the course of their work, but may not have in-depth knowledge and experience in this specialised area of care. The results have revealed some gaps in the evidence. AHPs and others are encouraged to fill these gaps by participating in relevant research.
We know that many of the interventions we carry out benefit those who receive them. We now need to prove it through research.
Email Sue Acreman MSc RD FBDA, formerly Chair of the National Cancer Rehabilitation Advisory Board and a Consultant AHP in cancer rehabilitation (now retired).
Sue would like to thank the members of the reference groups for their assistance.
NHS National Cancer Action Team. Cancer and Palliative Care Rehabilitation Workforce Project: A Review of the Evidence . November 2009.
NHS National Cancer Action Team. Cancer and Palliative Care Rehabilitation Workforce Project: A Review of the Evidence: Update [PDF 2.07 Mb]. January 2012.
Cancer rehabilitation pathways and the National Workforce Model are available from the NCAT website.