The Strategic Cancer Network (SCN)

Head and Neck Cancer Pathway:Who, What, When, Where and How?

Julie Hoole

MHSc, BSc(Hons), NMP Masters, RGN,DN, INLPTA.

Lead Macmillan Head and Neck Cancer Nurse Specialist/Project Manager

SCN Head and Neck Cancer Pathway!

Quality Criteria YCN Head & Neck Network Pathway v2.1 March 2011

i Referral *Urgent referral from GP or GDP with a suspicion of head and neck cancer

received by the Trust. Patient contacted within 24 hours and offered appointment within 14 days. Maxillofacial or ENT clinic indicated on the

referral proforma

© i Primary Care Assessment

GPs and GDPs to follow the DoH ‘Referral for Suspected Cancer’ guidelines. (If GDP has no access to fax – to send urgent letter or

telephone call)

a © First seen (ENT/Maxillofacial OPD) *Other non 2ww suspected Head & Neck Cancers may join pathway at this

stage and be upgraded where clinically appropriate(see Appendix a)

31

Maximum timeline in days

Keyi Patient informationa Holistic assessment© Key discussion point♦ Single contact with key worker

Cancer Waiting Times to be monitored

throughout the pathway

Criteria 1Patient & carer experience of

pathway

Criteria 2100% patients

discussed at an MDT with a

treatment plan decision

Criteria 3.1 Full staging to be available at MDT

discussion

Criteria 3.2 Audit percentage of patients seen by: Restorative Dentist, CNS, SLT, Dietitian

prior to starting treatment

Criteria 3.3 Treatment to be undertaken by

core members of the Head & Neck

MDT

Criteria 4100% of patients submitted to the Cancer Registry

Pathway Review date March 2014

© Biopsy and EUA or OPD Clinic for Results **Biopsy/ imaging results (see Appendix a)

© i Cancer Diagnosis Confirmed ** (see Appendix b)

Non Malignant Diagnosis Further management as

appropriate

© I Further Investigations/ completion of staging (see Appendix c)

© Specialist MDT Discussion Decision to treat date (see Appendix d)

a © I First Definitive Treatment (see Appendix e)

© Specialist MDT Follow up/Further Assessment SMDT decision regarding further treatment/any new imaging etc

a © I ♦ Second Line Treatment (if appropriate) within 31 days of Decision to Treat to the start of Treatment

· Radiotherapy +/- chemotherapy· Surgery· Palliative

a © I ♦ Follow Up & Rehabilitation (Minimum 5 years) Surgically led or may be joint oncology (see Appendix f)

Discharge (if appropriate) to primary care. Letter sent to GP

Recurrence or new primary tumour (return to first seen

stage)

a © I ♦ Survivorship/End of Life CareManagement as appropriate· Palliative Care/End of Life Pathway if appropriate· Survivorship

62

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a © I ♦ Pre-Treatment Assessment (ideally before 1st treatment) carried out by CNS/SALT/Dietitian/Physio/Psychology/ Restorative DentistAccess to ongoing dietetic assessment and support & restorative dentistry

Patient Information link number

1

2

3

4

6

5, 7 & 8

5

62 & 31 day Pathway

Who -Team approach-1 day

Primary Care Assessment

– GPs and GDPs to follow the DoH ‘Referral for Suspected Cancer’ guidelines. (If GDP has no access to fax – to send urgent letter or telephone call)

– Urgent suspected letter upgraded if suggested in the clinical letter.

Day 0-Referral

Referral assessment

– Urgent Suspect Cancer (USC) with a suspicion of head and neck cancer received by the Trust. Patients contacted within 24hrs and offered an appointment within 14 days.

– Maxillofacial or ENT designated clinics indicated on referral proforma

Preparing the patientWhy you are referring them

Your General Practitioner (GP) or General DentalPractitioner (GDP) has referred you to the Head and NeckSpecialist team on an urgent two-week-wait appointment.

You will receive an appointment asking you to come andsee one of the Head and Neck Doctors in the outpatientsclinics which are held at Pinderfields Hospital, Pontefractor Dewsbury hospitals. You may like to take a familymember or friend with you to help you to remember theinformation given.

This is because the symptoms you have described couldpossibly be caused by cancer – this does not necessarilymean you do have cancer. In fact the majority of patientswe see do not but it is important that you are seen and

assessed quickly at the hospital.

Bad news is always, however, in the

“Eye of the beholder,"

What does fast track mean? The Clock Starts

Every new patient is treated as having a cancer until proven otherwise

Quality Criteria YCN Head & Neck Network Pathway v2.1 March 2011

i Referral *Urgent referral from GP or GDP with a suspicion of head and neck cancer

received by the Trust. Patient contacted within 24 hours and offered appointment within 14 days. Maxillofacial or ENT clinic indicated on the

referral proforma

© i Primary Care Assessment

GPs and GDPs to follow the DoH ‘Referral for Suspected Cancer’ guidelines. (If GDP has no access to fax – to send urgent letter or

telephone call)

a © First seen (ENT/Maxillofacial OPD) *Other non 2ww suspected Head & Neck Cancers may join pathway at this

stage and be upgraded where clinically appropriate(see Appendix a)

31

Maximum timeline in days

Keyi Patient informationa Holistic assessment© Key discussion point♦ Single contact with key worker

Cancer Waiting Times to be monitored

throughout the pathway

Criteria 1Patient & carer experience of

pathway

Criteria 2100% patients

discussed at an MDT with a

treatment plan decision

Criteria 3.1 Full staging to be available at MDT

discussion

Criteria 3.2 Audit percentage of patients seen by: Restorative Dentist, CNS, SLT, Dietitian

prior to starting treatment

Criteria 3.3 Treatment to be undertaken by

core members of the Head & Neck

MDT

Criteria 4100% of patients submitted to the Cancer Registry

Pathway Review date March 2014

© Biopsy and EUA or OPD Clinic for Results **Biopsy/ imaging results (see Appendix a)

© i Cancer Diagnosis Confirmed ** (see Appendix b)

Non Malignant Diagnosis Further management as

appropriate

© I Further Investigations/ completion of staging (see Appendix c)

© Specialist MDT Discussion Decision to treat date (see Appendix d)

a © I First Definitive Treatment (see Appendix e)

© Specialist MDT Follow up/Further Assessment SMDT decision regarding further treatment/any new imaging etc

a © I ♦ Second Line Treatment (if appropriate) within 31 days of Decision to Treat to the start of Treatment

· Radiotherapy +/- chemotherapy· Surgery· Palliative

a © I ♦ Follow Up & Rehabilitation (Minimum 5 years) Surgically led or may be joint oncology (see Appendix f)

Discharge (if appropriate) to primary care. Letter sent to GP

Recurrence or new primary tumour (return to first seen

stage)

a © I ♦ Survivorship/End of Life CareManagement as appropriate· Palliative Care/End of Life Pathway if appropriate· Survivorship

62

14

0

-1

Head

& N

eck M

DT su

ppor

t and

pat

ient a

sses

smen

t/info

rmat

ion o

ffere

d at

all a

ppro

priat

e sta

ges o

f the

pat

ient p

athw

ay &

YCN

Sup

porti

ve a

nd P

alliat

ive C

are

Path

ways

follo

wed

a © I ♦ Pre-Treatment Assessment (ideally before 1st treatment) carried out by CNS/SALT/Dietitian/Physio/Psychology/ Restorative DentistAccess to ongoing dietetic assessment and support & restorative dentistry

Patient Information link number

1

2

3

4

6

5, 7 & 8

5

62 & 31 day Pathway

7

38

Oncology ClinicFirst Visit-What happens?

Oncology ClinicFirst Visit-What happens?

Examination Biopsy / FNA 7days

– Future-Core Biopsy neck lump

Book MRI and CT scans 10 days

Available– Specialist nurse

– Dietician

– Speech and language therapist

– Wellbeing alcohol specialist nurse/detox planning………

Midyorkshire head and neck audit newly diagnosed cancer patients

62%

What about those that were benign disease? They have not been asked this question?

Did not know what to expect -1st visit

Who is responsible?

1. Referrer Preparation

Consent

Preparation Hospital Trust/team receiving the referral Leaflet

‘Cancer’

Preparing the patient and yourself

Obstacles to breaking bad news

Obstacles to breaking bad news

Fear of causing painFear of own emotionsFear of being blamedFear of doing badly – the untaughtFear of the patients reactionsFear of damaging the patient or making things worse Fear of having to admit “I don’t know”Fear of illness/death of self

Distancing Techniques

Distancing TechniquesNormalising

Premature reassurance/False reassurance

Passing the buck

Switching the subject

Jollying along

Closed questions

Selective attention

"There is nothing so easy to learn as experience and nothing so

hard to apply."

(Josh Billings)

“Don't let what you cannot

do interfere with

what you can do.”

(John Wooden)

Macmillan’s own research reveals that the number of people living with cancer diagnosis in the UK today is 2 million. That number is set to double to 4 million by 2030. Cancer patients are living longer after their diagnosis than they did 30 years ago, cancer is increasingly about living with cancer with many people experiencing issues which require support several years after initial diagnosis and treatment.’

Macmillan ,2013

Multi professional Approach

Thank you