Understanding the link between health systems and cancer survival

Understanding the link between health systems and cancer survival: A novel methodological approach using a system-level conceptual model
Journal of Cancer Policy v25, September 2020, 100233

• Health system contribution to variation in cancer outcomes remains largely unexplained. This paper presents a conceptual model which depicts the complex interactions along the cancer care pathway. Possible ‘breakpoints’ are highlighted which may have adverse impacts on outcomes. The model provides a novel way to identify where health services could be adapted.

Streamlining Multi-Disciplinary Team Meetings – Guidance for Cancer Alliances

Streamlining Multi-Disciplinary Team Meetings – Guidance for Cancer Alliances
NHS England 14 January 2020

• This guidance has been developed to enable cancer multi-disciplinary teams (MDTs) to respond to the changing landscape in cancer care, as recognised in the NHS Long Term Plan and the Independent Cancer Taskforce Report. MDT Streamlining will be supported by agreeing Standards of Care (SoCs) across Cancer Alliances. These SoCs will set out the treatment or care patients should expect to receive

Evidence for a dedicated non-specific symptoms pathway

Cross-sectional study using primary care and cancer registration data to investigate patients with cancer presenting with non-specific symptoms
BMJ Open 2020;10:e033008. 10 January 2020. doi: 10.1136/bmjopen-2019-033008

• Patients with non-specific symptoms have not typically had access to a dedicated referral pathway. To address this imbalance, ACE piloted the Multidisciplinary Diagnostic Centre (MDC) concept in England over the period 2017-2018. To better understand the current experience of this cohort of patients ACE linked cancer registrations from 2014 with primary care information from the National Cancer and Diagnosis Audit. This paper compares MDC-similar patients (those with non-specific symptoms) to those who had a symptom which would usually result in an urgent referral.
• Analyses showed that non-specific symptoms patients were more likely to be diagnosed at stage 4, have multiple visits to the GP and experience longer primary care intervals. Differences in the diagnostic pathway show that patients with symptoms mirroring the MDC referral criteria could benefit from a new referral pathway.

Whole-body MRI compared with standard pathways for staging metastatic disease in lung and colorectal cancer

Whole-body MRI compared with standard pathways for staging metastatic disease in lung and colorectal cancer: the Streamline diagnostic accuracy studies.
Health Technol Assess 2019;23(66) December 2019

• In colorectal and non-small-cell lung cancer, the whole-body magnetic resonance imaging staging pathway has similar accuracy to standard staging pathways, is generally preferred by patients, improves staging efficiency and has lower staging costs. Future work should address the utility of whole-body magnetic resonance imaging for treatment response assessment.

A review of the implementation of the national optimal lung cancer pathway

A review of the implementation of the national optimal lung cancer pathway
UK Lung Cancer Coalition October 2019

• This report highlights best practice examples identified by Cancer Alliances as well as challenges that need to be addressed to enable the wider roll-out of the National Optimal Lung Cancer Pathway (NOLCP).

MRI for patients with CIEDs: simplifying complexity with a ‘one-stop’ service model

MRI for patients with cardiac implantable electronic devices: simplifying complexity with a ‘one-stop’ service model
BMJ Quality & Safety 2019;28:853-858, 19 September 2019

• MRI scanning for patients with cardiac implantable electronic devices (CIEDs) requires some additional steps to be taken both prior to imaging and on attendance. 
• A one stop service model [Barts Hospital NHS Trust, London] whereby CIEDs could be reprogrammed and scans acquired at a single location on a single visit is described, including workforce impact, and development of a standard booking protocol. No additional equipment or other fixed costs were needed. After 2 years, scan volume was over 20 times the national average with a lower waiting time, and while maintaining total departmental activity.

Hospital-level evaluation of the effect of a national quality improvement programme: time-series analysis of registry data

Hospital-level evaluation of the effect of a national quality improvement programme: time-series analysis of registry data
BMJ Quality & Safety 12 September 2019. doi: 10.1136/bmjqs-2019-009537

• Analysis using data from the Enhanced Peri-Operative Care for High-risk patients trial (a quality improvement programme for emergency abdominal surgery across 92 NHS hospitals) demonstrated a large variation in implementation approaches but no mortality reduction.  
• Hospital level evaluation indicated that only a small number of hospitals in the trial improved more than half of the 10 measured care processes, more often when at least five of six implementation strategies were used.

Abstract

Comparing modular and personal service delivery in specialised outpatient care: A survey of haematology and oncology patient preferences

Comparing modular and personal service delivery in specialised outpatient care: A survey of haematology and oncology patient preferences
Health Services Management Research Volume: 32 issue: 4, page(s): 209-217, 12 August 2019 https://doi.org/10.1177/0951484819868681

• This study compares preferences of oncology patients treated by named nurses in a traditional specialty-focused day hospital and haematology patients treated without named nurses in a modularised day hospital. 
• The findings suggests that patients can be satisfied with outpatient care with or without named nurses. However, as several factors affect patient satisfaction and experience, more in-depth research is needed to understand how modularisation and patient preferences may be linked.

Abstract

Whole-body MRI is effective for identifying metastatic disease in colorectal cancer patients - prospective Streamline C trial

Whole-body MRI is effective for identifying metastatic disease in colorectal cancer patients - prospective Streamline C trial
NIHR Signal 23 July 2019

• Initial investigation which includes whole-body magnetic resonance imaging (MRI) is as good as standard pathways for detecting metastatic disease in adults with newly diagnosed colorectal cancer. The study also found that whole-body MRI reduces the number of investigations needed, the length of the staging process, and costs less than standard pathways.
• Current NICE guidance recommends a sequence of investigations for staging, with MRI only recommended after biopsies and other imaging investigations. This study suggests that MRI could be used earlier in the process, instead of the currently recommended investigations. However, any changes to guidance would need to take into account the availability of this resource.
• Study: The Streamline C trial was a prospective, multicentre trial done in 16 hospitals in England between 26 March 26 2013 and 19 Aug 2016. Eligible patients were 18 years or older, with newly diagnosed colorectal cancer, 1020 patients were screened for eligibility. 370 patients were recruited, 299 of whom completed the trial.

Whole-body MRI scans are as accurate as standard imaging pathways for lung cancer staging - the Streamline L trial.

Whole-body MRI scans are as accurate as standard imaging pathways for lung cancer staging - the prospective Streamline L trial.
NIHR Signal 23 July 2019

• Using whole-body magnetic resonance imaging (WB-MRI) in the initial investigation pathway is as good as standard pathways for detecting metastatic disease in adults with non-small-cell lung cancer. The study (Streamline L trial) also found that WB-MRI used for diagnosis and staging is quicker, cheaper and requires fewer other investigations than standard pathways.
• Current NICE guidance recommends a sequence of investigations for staging – assessing the extent of cancer in order to plan appropriate treatment. MRI of different areas of the body is only recommended after other imaging investigations. This study suggests that whole-body MRI could have a role earlier in the pathway.
• Study: The Streamline L trial was a prospective, multicentre trial done in 16 hospitals in Englandca rried out between 26 Feb 2013 and 5 Sept 2016. 976 patients were screened for eligibility. 353 patients were recruited, 187 of whom completed the trial.

Chemotherapy at home in Cheshire and Merseyside

Chemotherapy at home in Cheshire and Merseyside
Innovation Agency, the Academic Health Science Network for the North West Coast, 6 July 2019

• Evaluation of a trial of chemotherapy treatment (subcutaneous administration of trastuzumab) at home and subsequently in the workplace delivered by The Clatterbridge Cancer Centre NHS Foundation Trust.
• Economic analysis by the Royal College of Physicians over the course of 2017 estimated savings to the trust of £182 per treatment episode at home compared to in the hospital, resulting in total estimated savings of nearly £400,000. The research did not take into account NHS patient transport costs or missed appointments, meaning that total savings to the NHS are almost certainly higher.

ACE MDC project approaches to understanding pathway cost

ACE MDC project approaches to understanding pathway cost
Cancer Research UK, July 2019

• As part of Wave 2 of the ACE Programme, five projects across England tested the viability of the Multidisciplinary Diagnostic Centre (MDC) model as an approach to improving outcomes for patients presenting with non-specific but concerning symptoms. This article addresses the challenges associated with achieving a full and rigorous evaluation of MDC cost effectiveness, before describing some of the practical approaches employed at a project level to understand pathway cost.

Establishing MRI-guided prostate intervention at a UK Centre

Establishing MRI-guided prostate intervention at a UK Centre
Br J Radiol. 2019 Jun; 92(1098):20180918. doi: 10.1259/bjr.20180918. 

This article gives an account of establishing the first MRI intervention suite in the UK [University Hospital Southampton NHS Foundation Trust]. It demonstrates some of the logistical considerations, and offers the unit's early experience.

Abstract

A pathway for post-transplant care

A pathway for post-transplant care
Anthony Nolan May 2019

• A post-transplant care pathway has been developed by Anthony Nolan under the leadership of an Expert Steering Group for patients who have had stem cell transplants.
• The pathway consists of five main building blocks: (1) throughout recovery, (2) preparation for transplant, (3) early post-transplant care, (4) ongoing prevention and monitoring, and (5) additional treatment and support.

ACE PROGRAMME (WAVE 2): Key messages from the evaluation of MDCs

ACE PROGRAMME (WAVE 2): Key messages from the evaluation of Multidisciplinary Diagnostic Centres (MDC)
Cancer Research UK May 2019

• This summary report highlights the key findings from the five MDC projects and draws together the learning gained from their implementation. It also includes the most recent data on patient characteristics, cancer yield, and pathway activity.
• Headline findings from the MDC evaluation currently suggest that the MDC model: 
• has value as a cancer diagnostic pathway for patients presenting with non-specific but concerning symptoms
• is diagnosing a broad range of cancer types, including rare and less common cancers
• should be considered as an approach to achieving earlier diagnoses of cancer for patients presenting with non-specific symptoms, given the types of cancer being detected
• provides a broad diagnostic approach encompassing a range of cancer and non-cancer conditions
• provides a planned and rapid pathway for patients with complex presentation

Elective care pathway analyser for referral to treatment

Elective care pathway analyser for referral to treatment
NHS Improvement 16 July 2018 updated 10 April 2019

• A tool to help you identify the main reasons for delays in referral to treatment and help operational teams to focus on interventions that will have the biggest impact on reducing waiting times.

Hyperacute neurology at a regional neurosciences centre: a 1-year experience of an innovative service model.

Hyperacute neurology at a regional neurosciences centre: a 1-year experience of an innovative service model.
Clin Med (Lond). 2019 Mar;19(2):119-126. doi: 10.7861/clinmedicine.19-2-119.
This paper reports the results from the first year of the St George's Hospital hyperacute neurology service (HANS). The outcomes include admission avoidance from ED, and a reduction in length of stay for non stroke patients and reduction in occupancy of stroke beds by non-stroke cases.

Abstract

Breast open access follow up programme Royal Marsden NHS FT

Breast open access programme
NHS Improvement 15 February 2019

• This case study from The Royal Marsden NHS Foundation Trust provides information on the change in pathway that allowed the trust to absorb a 22% increase in outpatient breast referrals through through a breast open access follow-up programme.

MRI for patients with cardiac implantable electronic devices: simplifying complexity with a ‘one-stop’ service model

MRI for patients with cardiac implantable electronic devices: simplifying complexity with a ‘one-stop’ service model.
BMJ Qual Saf Published Online First: 13 February 2019. doi: 10.1136/bmjqs-2018-009079

• Evaluation of a streamlined sustainable service that provides timely MRI scans to patients with cardiac implantable electronic devices (CIEDs) whereby devices could be reprogrammed and scans acquired at a single location and visit. Over 2 years MRI provision increased 6 to 20 times the national average with reduced waiting time from 60 to 15 days and no adverse events.
• Location - Barts Health Trust, London

Abstract

Elective care: model access policy

Elective care: model access policy NHS Improvement 18 August 2017 updated 24 January 2019  

• The purpose of this policy is to ensure all patients requiring access to outpatient appointments, diagnostics and elective inpatient or day-case treatment are managed in line with national waiting time standards and the NHS Constitution. 
• Includes general principles, pathway-specific principles referral to treatment and diagnostic pathways, and Cancer pathways.