Cancer Reform Strategy - NHS Cancer Screening Programmes

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80 CANCER REFORM STRATEGYWork and cancer5.55 Cancer can have a profound impact onpeople’s ability to work. Each year around 90,000people of working age are diagnosed withcancer. Some of these will require protractedperiods of time off work due to the impact ofcancer and its treatment. Some may never beable to get back to work. However, for otherscontinuing to work helps them to cope withwhat they are going through. An individuallytailored approach is therefore needed.5.56 From 2005, cancer patients have beenprotected by the Disability Discrimination Actfrom the point of diagnosis. The Act providespeople with rights in a wide range of areas andplaces a duty on employers, providers ofservices, public authorities and transportproviders not to discriminate against disabledpeople and make reasonable adjustments forthem. In the area of employment, examples ofreasonable adjustments might be allowing anemployee with cancer time off for treatment orrehabilitation, or allowing them some flexibilityin working hours or a phased return to work.Occupational Therapists play an important rolein helping people return to their desiredoccupation. However further work is necessaryto increase employers’ awareness of the role ofcancer within the Act. Although 80% ofemployers are aware of the Act, only 19% knowthat cancer is classed as a disability. 335.57 A recent survey undertaken by Workingwith Cancer (a dedicated support group),Cancerbackup and the Chartered Institute ofPersonnel and Development highlighted theneed for better advice on work related issuesrelating to cancer and its treatment.Cancerbackup and Working with Cancer haveproduced guidance for employers andemployees. Guidance for carers will bepublished early in 2008.Surviving cancer5.59 Macmillan Cancer Support defines acancer survivor as someone who has completedinitial treatment and has no apparent evidenceof active disease, or is living with progressivedisease and may be receiving treatment but isnot in the terminal phase of illness, or someonewho has had cancer in the past.5.60 Survivors of cancer have a range ofphysical, psychological, social, spiritual, financialand information needs. At present servicesfrequently do not meet these needs for patientsor are poorly integrated. As many patients withcancer are elderly and have other medicalproblems, services for survivors need to be wellintegrated with those for other long termconditions. This is often best done by GPs andprimary care services.5.61 Problems relating to the after effects oftreatment for cancer can, in some cases, be longlasting and severely debilitating. Examplesinclude lymphoedema (swelling of a limb)following surgery and/or radiotherapy andbrachial plexopathy, which can cause pain andweakness in an arm. Macmillan Cancer Support,with funding from the Department of Health iscurrently running an innovative pilot programmeto assess how the needs for care of brachialplexopathy sufferers can best be met.5.62 Follow up by a hospital team has for manyyears been considered to be a standard part ofthe management of a cancer patient. Howeverpatients frequently undergo follow up, both at ahospital and in primary care, but without goodcommunication between the two, leading toduplication of effort and in some cases,confusion.5.63 Hospital follow up is undertaken withseveral objectives. These include:5.58 Commissioners should make sure thatinformation for people who work and havecancer is made available to patients as soonas they are diagnosed. Advice on returningto work should be available for all patientsof working age. Employers should beencouraged to support employees whowish to do so.●●●Detection and management of acutecomplications or side effects of treatment;Early clinical detection of recurrence;Detection of late effects of treatment such aslymphoedema or secondary cancers;
CHAPTER 5: LIVING WITH AND BEYOND CANCER 81●●Psychological assessment and support; andTo arrange surveillance investigations such asblood tests, CT scans and endoscopies.5.64 In practice, follow up consultations areoften brief, are conducted by relatively juniordoctors and may not meet patients’ needs.5.65 Alternatives to hospital follow up havebeen successfully introduced in some places andfor some cancer types. For example:●●Reducing the frequency of follow up insecondary care, meaning less visits tohospital;Transferring follow up to primary careaccording to predetermined protocols, sothat appointments can happen closer tohome;●●●●●●●●●Education, self care and expert patientprogrammes;Proactive case management, for example bytelephone contact;Drop in centres for peer support;Automated surveillance systems to ensuretests are undertaken at appropriate intervals;Patient reports of wellbeing using electronictechnology such as mobile phones;Provision of rehabilitation programmes;Psychological and spiritual support;Back to work support;Access to financial and benefits advice;●●Nurse led follow up (in hospital or primarycare); andReleasing patients from routine follow up,but giving them direct access back to theclinical team in relation to agreed “triggers”.5.66 Further detailed consideration now needsto be given to the services needed by survivorsof cancer. The National Cancer Director willlead a new National Cancer SurvivorshipInitiative to take this forward in partnershipwith Macmillan Cancer Support and othercancer charities. This initiative will requirecollaboration between clinicians working inprimary and secondary care, social care services,service users and patients and the voluntarysector. It will also link closely to ongoing workfor patients with other long term conditions.5.67 The National Cancer Survivorship Initiativewill consider a range of approaches tosurvivorship care and how these can best betailored to meet individual patients’ needs.These include:●Clinical follow up by hospital doctors, nursesand/or GPs (such as to detect recurrence andmonitor late effects of treatment);●●Nutritional advice; andOngoing support for carers.5.68 The National Cancer Survivorship Initiativewill also look in more detail at best practiceregarding care planning for survivorship. This islikely to include formal assessments of apatient’s needs and preferences for care at thecompletion of treatment and what role thepatient wishes to take in managing their owncare.5.69 As part of this work, Macmillan CancerSupport will host a think tank event,Making the Cancer Survivorship Agenda aReality, in March 2008. The key outcomes ofthe event will be: to identify key policywork streams and priorities; to agreestakeholder involvement for each of thepolicy work streams; and to produce areport outlining the outcome of the eventfor wider circulation. The event will beco-chaired by the National Cancer Directorand the CEO of Macmillan Cancer Supportand will involve patients, healthprofessionals, the voluntary sector,academics, research experts, internationalexperts and the government.
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Cancer Reform Strategy
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DH INFORMATION READER BOXPolicyHR/W
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3Forewordby the Prime MinisterAt on
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6 CANCER REFORM STRATEGY9. Your NHS
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8 CANCER REFORM STRATEGY9. Excessiv
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10 CANCER REFORM STRATEGYWe will al
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What the Cancer Reform Strategy mea
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14 CANCER REFORM STRATEGY●●●R
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17Chapter 1:The challenge of cancer
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CHAPTER 1: THE CHALLENGE OF CANCER
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Annexes
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135Annex 2:References1 Cancer is ou
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ANNEX 2: REFERENCES 13737 K. Moser,
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