Living with and beyond cancer: The improvement story so far - NHS ...

50 | Living with and beyond cancer: The improvement story so far
Velindre Cancer Centre
Implementing a ‘virtual’ non medically led adjuvant
Herceptin breast cancer pathway
Summary
Velindre Cancer Centre (VCC) provides
non surgical cancer services to a
population of 1,400,000 in South East
Wales Cancer Network (SEWCN). This
equates to over 1,000 new breast
cancer patients presenting to VCC with
approximately 200 patients (20%)
eligible to receive adjuvant Herceptin
treatment following chemotherapy
annually.
The current Herceptin pathway involves
patients receiving 18 treatments over a
12 month period. During which time,
patients receive six MUGA scans to
monitor cardiac function and attend six
outpatient appointments (OPA) which
impacts significantly on capacity.
Patients told us what they didn’t like:
‘Waiting times’, ‘seeing a different
person all the time’, ‘stressful waiting
for scan results’ and ‘not knowing
when their appointments were going
to be’.
Comparative baseline data collected on
30 patients who had been through the
medical model showed:
• The majority of patients attended
hospital 12 times during their
Herceptin treatment
Baseline costs and potential savings
Medical pathway
• The average patient spent 19 minutes
with consultants and one hour and
seven minutes waiting in the
outpatient clinic (total one hour and
26 minutes)
• 43% of patient live within five miles
• Patients travelled an average distance
of 35 miles taking 54 minutes each
journey per outpatient appointment
• Additional journeys required for
MUGA scans
• Costs for current and potential
pathways outlined and potential
savings identified.
Non medical pathway
Postal savings
Following review and feedback from
patients, a new non medical Herceptin
treatment pathway has been designed
that improves the quality of the service
and reduces the number of OPA.
Utilising the skills of a non medical
prescriber (NMP) and the resources of
electronic prescribing with telephone
follow up in a virtual clinic, replaces the
need for patients to come to hospital
for follow up and results.
OPA x 1 @ £178 £178
OPA x 6 @ £69 £414
Per patient £592
X30 patients £17,760.00
Telephone
clinic x 3
@£23 £69
£69
£2,070
OPA
x 7
@£69 £592
£523
£15,690
What were the issues
Clinic capacity issues and waiting times
are an increasing challenge to
managers and clinicians in the cancer
setting within VCC. Patients can
experience high levels of anxiety and
stress waiting for test results. The
current Herceptin pathway has a
significant impact on both resources
and capacity at VCC. Many patients
travel long distances over hours often
for a 10-15 minute appointment with
the oncologist.