Cancer support in Lincolnshire focuses on providing support for our patients during and beyond their cancer diagnosis. Find out more about the work we are doing across Lincolnshire to support our local population.
Reviews, HNA's & Treatment Summaries
Holistic Needs Assessment (HNA)
People living with cancer also live with other long-term conditions which may impact on their holistic needs once they get a cancer diagnosis. The completion of a HNA ensures people's needs can be fully identified and appropriate support planned. This is why every patient should be offered a HNA within 31 days of their diagnosis. A HNA is a tool to discuss an individuals needs based on six different domains;
• Practical
• Physical
• Emotional
• Spiritual
• Mental
• Social
Most patients will be given a copy of a HNA when they receive their diagnosis, which triggers the formal HNA offer within 31 days. From this point, a Cancer Nurse Specialist or Cancer Care Co-ordinator will usually offer a follow up phone call a week or two later to complete the HNA. This allows the patient to know what to expect during the HNA phone call, and some patients may have also completed the HNA at home. Asking some of the HNA questions can be difficult, they can be very personal, so building up a positive relationship with the patient first can be important. The questions on the HNA are broad, so asking more specific questions can be important. I.e. “You’ve said you get insomnia; can you tell me a bit more about that? What’s your sleep pattern normally like?”. Completing the HNA can allow the patient to recognise what they are doing well and how they are managing to cope on their own with personal coping strategies. The HNA isn’t there to necessarily solve all the issues a patient is facing, and can be used to acknowledge them and escalate where appropriate. Sometimes the completion of a HNA is all the patient needs to feel valued and supported. Signposting to relevant services can be helpful. The HNA gives professionals a good understanding of the patient’s lives and their baseline of activities as we know that when patients undergo gruelling treatment their needs can change.
Personalised Stratified Follow UP
Personalised Stratified Follow up (PSFU) is designed to adapt care for cancer patients after cancer treatment, to ensure that we provide the best possible care to our patient. It offers huge benefits, to both the patient and NHS system, through utilising follow up pathways tailored to an individual’s needs. PSFU is a package of measures which includes a risk stratified decision related to an individual follow, an End of treatment HNA and treatment summaries. It is designed to ensure that a patients needs are addressed beyond the medical management of their diagnosis.
PSFU often looks like a Stratification of a patient during a Multi Disciplinary Team (MDT) discussion whether a patient is suitable for self supported follow up, Nurse led follow up or Consultant led follow up. These decisions are often made during an MDT as a Consultant may feel a patient is suitable for self supported management, but the Cancer Nurse Specialist may highlight concerns when considering their holistic needs. Working together, the team agree a follow up pathway appropriate to best support the patients needs.
Treatment Summaries
A Treatment Summary is a document produced by acute care staff at the end of initial treatment for cancer. Depending on the tumour site, the Treatment Summary may be completed by the Cancer Nurse Specialist or the Consultant. The Treatment Summary is written for the patient and so is written in a language the patient can understand and doesn’t often contain medicalised words or jargon. A copy will also be shared with the patient’s GP surgery.
In United Lincolnshire Teaching Hospitals, we have developed a unique standardised treatment summary template which each tumour site will then be using to add in their own specific care details. This exciting and innovative method of delivery will support patients as they will know what to expect at each stage of their treatment.
The Cancer Treatment Summary will contain:
an overview of any treatment the patient has received
details of any potential side effects of treatment
the signs and symptoms of cancer recurrence
contact details to address any concerns.
A copy of the Cancer Treatment Summary is sent to the GP surgery and will support future conversations with patients.
Cancer Care Reviews
Cancer Care Reviews were previously delivered in line with QOF requirements. While this is no longer mandated in the same format, it is encouraged that practices continue to offer these reviews, either in their original form or adapted to best meet the needs of their local population and the capacity of the practice.
At the heart of any type of cancer care review is a holistic, personalised conversation. This is a key element of personalised care, creating space for individuals to discuss their concerns, better understand the support available within their community, and access information that can support self-management where appropriate.
The review is a conversation between a person diagnosed with cancer and a GP or practice nurse. It focuses on addressing the individual’s wider needs, not solely their diagnosis. This includes an opportunity to discuss their cancer treatment, any side effects they may be experiencing, and to undertake a medication review, including advice on prescription entitlements.
Importantly, the review also provides a dedicated time to consider the needs of the individual and, where appropriate, their carer. This may involve signposting or referral to additional support services, such as local community resources, physical activity opportunities, and organisations such as Macmillan, ensuring a coordinated and supportive approach to care.
Clinical Systems
Gateway C
This is a free online cancer education platform, offering both e-learning courses and webinars, developed for primary care professionals across England, aiming to improve cancer outcomes, facilitate early diagnosis and improve patient experience. The platform has been nationally funded by Health Education England and is intended to be used by all professionals across PCNs and Practices.
Somerset Cancer Register (SCR) provides a Remote Monitoring System that is integrated and enables a complete electronic cancer record for the patient. The digital RMS covers breast, colorectal and prostate tumour sites. More tumour sites will come online soon.
RMS links to SCR which means demographic and clinical data about the patient will pull over when the patient is registered. There is also a dynamic lookup with data captured in SCR, so you will always have access to the latest information about the patient via RMS.
RMS covers:
Ability to create a personalised record for each patient
Customise follow-up activities to suit patient needs
Charting of patient results against agreed thresholds and safely monitor
Real time view of SCR investigation data
Configurable letters
Easy to use worklist for caseload management and monitoring of tests
Supplementary alerts to assist staff or patients with specific activities
Interoperability of data, reducing the need for double data entry.
The Breast Pain Pathway was launched in Lincolnshire March 2022 and is now actively receiving referrals. It has been created for people presenting with Breast Pain as a single symptom.
Breast Pain alone is not a symptom of cancer, so this pathway has been designed to offer an appropriate service for people where they are not seen in a cancer clinic setting and they do not experience increased anxiety related to cancer unnecessarily. This pathway also helps to reduce the demand on the Breast 2ww pathway so that people with a genuine suspicion of cancer are seen quicker, and they are not delayed by an unnecessary appointment being booked in before them.
Please see the links below for the Breast Pain Pathway referrals process, and associated documents that support the pathway.
The prehabilitation service supports people with a cancer diagnosis to be in the best possible health before they start their cancer treatment. Preparing patients for their treatment will help them to recover quicker, alongside supporting their longer-term health and wellbeing too. The prehabilitation service is occupational therapy-led. The service works as part of the wider multidisciplinary team that supports people to achieve health and wellbeing.
We have been working on a joined-up approach across the whole system to implement necessary changes to the 2ww Colorectal pathway. Please be aware of the agreement that has now been reached with GP Clinical Leads and ULHT:
From 7th November 2022, we will be using the Rapid Access Colorectal Pathway (RACP) in place of the Colorectal 2WW pathway
The Rapid Access Colorectal Pathway requires set criteria to be met to refer patients into ULHT. Details of the clinical criteria for referring a patient are below:
How do I refer a patient onto RACP?
It is essentialthat a patient referral on the RACP pathway is accompanied with the following:
(4F’s)
FIT result
FBC Result
Ferritin result
Digital Rectal Examination (DRE)
*Please note, a FIT result is not required for Anal Rectal Mass or Anal Ulceration.
If your patient’s FIT result is negative with no concerning symptoms, we ask you to manage, and safety net the patient in Primary Care.
If, however, you remain concerned, please access the advice and guidance via eRS. The Consultant will review this A&G within 48 hrs and either contact you with information to manage your patient in Primary Care or the Consultant will refer your patient onto a routine/urgent or 2WW pathway. This may include diagnostic tests so please prepare your patient for this.
Safety Netting your Patients
Please see below for information on safety netting. Clinical teams should consider:
Providing the patient with clear information about who to contact if they develop new symptoms or if their existing symptoms worsen
Consider using advice and guidance via eRS to guide management of patients with persistent or troublesome symptoms
Consider offering a second FIT test 14 days later if ongoing clinical concerns remain. Results from a recent study show patients with two negative FIT test results have a colorectal cancer risk of <0.04% (1)
Consider a referral to a non-specific-symptoms urgent cancer pathway, if appropriate and there are ongoing concerns about possible cancer
We will be issuing a new referral form via Systm1, EMIS and Ardens, it is imperative that the old 2WW form is not used and is removed if saved locally as any submitted will be returned.
We will be applying an administrative triage in secondary care at the front of the pathway to ensure all elements are complete and the patient is appropriate for referral. If not complete, we will contact the practice to re-refer with the relevant elements completed.
Contact Us
If you require any further clarification, please contact Mr Milind Rao or Jodie Waddington. (Jodie.waddington5@nhs.net)
Rapid Diagnostic Service Non-Specific Symptoms pathway - RDS NSS
(Previously known as The Rapid Diagnostic Concept)
The NSS pathway will focus on introducing a pathway that will fulfil the role of delivering faster and earlier diagnosis as well as improving patient experience for patients with vague but concerning symptoms. This pathway will align to the 7 RDS principles –
NHS cancer screening programmes can help to diagnose cancer or risk of cancer earlier and improve the likelihood of successful treatment. There are three national cancer screening programmes in England.
Cervical screening is offered to people with a cervix aged from 25 to 64. Routine screening is offered every three years up to 49 years of age and every five years from 50 to 64 years of age.
Bowel Screening is offered to men and women aged 60-74, who are sent a home testing kit every two years to collect a small sample of poo to be checked for tiny amounts of blood which could be caused by cancer.
The Lincoln Pelvic Late Effects Service is dedicated to helping people who are 6 months or more post treatment, to manage and live well with the late effects from radiotherapy.
To find out more about the Pelvic Late Effects Service, please refer to the presentation below:
Cancer Care Map is a simple, online resource that aims to help you find cancer support services in your local area wherever you are in the UK. Cancer Care Map is run by The Richard Dimbleby Cancer Fund charity.
Lincolnshire has recently been working closely with Cancer Care Map to include over 580 additional community assets to be added to the Cancer Care Map.
Connect to Support Lincolnshire is an online information and advice library, community directory and marketplace for adults in Lincolnshire.
The website is intended for adults who want to find out about local groups, activities and services within the community.
There are over 600 listings for cancer services within Lincolnshire.
Telephone support and live web chat is provided by Lincs 2 Advice.
H.O.P.E stands for Help Overcoming Problems Effectively. It is a licensed programme that helps people who have had cancer to move forward with their lives.
It is free to attend and runs over 6 weeks. Each session is 2.5 hours once a week. It is run by a Macmillan trained HOPE facilitator. This is a health professional from within the Cancer workforce and a volunteer who has had a cancer experience themselves. There are between 6-12 people on each course, and time is spent in facilitated discussions, with group activities, information sharing and ideas for participants to try in between the sessions.
To book a place or find out more information, please call the Macmillan Information and Support Service on 01522 573799
Look Good Feel Better is a national charity, with the focus on helping to boost the physical and emotional wellbeing of people living with cancer through free workshops that address issues of skin care / make up / hair care/ wig advice / grooming and nail care. Each session is hosted by trained volunteers within the beauty industry who can tackle some of the problems that might be faced throughout treatment.
