The Macmillan Aftercare
Rehabilitation Service
(“MARS”)
Providing a service for people who
have, or have had,
head and neck cancer
Content
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Who are the MARS team?
Why have we formed?
What do we do?
Where are we going?
Who are the MARS Team?
A team of Allied Health Professionals (“AHP”)
specialising in Head and Neck cancer (“HNC”),
comprising:
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Dietitians, Speech & Language Therapist, Nutrition Nurses,
Care Co-ordinator
Based at the Royal Surrey County Hospital, (RSCH)
Guildford, with outreach clinics at Frimley Park, East
Surrey, St Peter’s and Basingstoke Hospitals
Working alongside the H&N Consultants
Close liaison with the CNS
Why have we formed?
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Lack of local specialist aftercare services in Surrey
Number of cancer survivors continues to grow;
HNC rates ↑ by >20% past 30yrs, particularly in
those <65years and both sexes (NICE, 2004)
Need for support & care may be greatest at
treatment end (Roing et al, 2007, Semple et al, 2008)
Post-treatment HNC pts report high unmet
supportive care needs, most vulnerable in the
post-treatment phase + unprepared for lifestyle
changes (Ziegler et al, 2004, Larsson et al , 2005, Chen et al, 2009)
The long and winding road….
Rehabilitation Peak
Treatment end and recovery starts...
Aims of the MARS team:
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To provide a collaborative patient-centred
specialist service to address the complex needs of
this patient group, at a location close to the
patients home
To help obtain optimal functioning after treatment
(within limits of the disease + personal situation)
To promote self-care/management in a supportive
environment + access to resources
To meet national and local policies & guidelines on
cancer survivorship
Compliance with National and
Local policies & guidelines:
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To help more people survive cancer, all cancer pts to
receive a recovery package of ongoing support after
treatment. Aim for a seamless effective integrated
discharge service (Department of Health: GB, 2013)
To improve Quality of Life as well as longevity; better
outcomes/experience for ca survivors, unplanned
+unnecessary hospital appts + admissions. (NCSI, 2011)
(Healthy People, Department of Health: GB, 2010)
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To provide a uniform high quality multidisciplinary local
support service for HNC patients (Calmine Hine report, BAHNO,
1996) (IOG, 2004)
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To encourage patients with long-term conditions towards
self-empowerment to manage their own health (Cancer
Workforce Development Strategy 2010-2015)
Benefits of service provision
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One-stop MDT approach
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Continuity of care
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Frees up appointments at RSCH
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Clinics local to patient homes
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Enables patients to remain at home longer
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Improved patient experience and satisfaction
MARS Dietetic Intervention
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72% HNC pts on modified textured diets, supplements
+/- tube feeds 1 yr post-treatment (Garcia-Peris et al, 2007)
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Acute/chronic side-effects of HNC treatment
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Regular assessment of tube feeds & supplement usage
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Advice & support on all aspects of nutritional intake,
weight management & healthy lifestyle choices
following recovery from treatment
MARS Nutrition Nurse
Intervention
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Advice and support post feeding tube
insertion
Regular assessment of feeding tubes
Early detection of complications or
potential complication
Timely removal of feeding tubes
Prevention of unnecessary hospital
admissions
MARS Speech & Language
Therapy Intervention
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Advice, support and exercises to maximise speech
and swallow function
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Advice and support for patients, carers and the
MDT following laryngectomy
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Including providing diet/fluid modification advice & conducting
bedside/instrumental swallow assessments
Without speech and swallowing intervention, 12 months post
treatment the oral cancer patients speech and swalow function is no
better than 3 months post treatment (Pauloski et al , 1994)
Including surgical voice restoration, stoma care,
filtration/humidification, use of artificial larynx etc
Acute/in-patient visits
MARS Care Co-ordinator role
The Care Co-ordinator acts as the single point of access for acute and
local Head and Neck teams
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Closely liaising with the RSCH Head & Neck CNS
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Involves referral processing, telephone triage and patient support
Tasks include:
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Triage of patients, sign-posting and problem solving
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Providing individualised information
Giving advice on:
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Recurrence avoidance and recognition
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Long Term side effect management
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Finance- Macmillan healthcare grants, or Macmillan CAB
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Smoking cessation support
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Patient feedback projects
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Rehabilitation
Supported
by MARS
Treatment End
Where are we going?
Development:
 Resources
 Outcome measures
 Practical support
sessions:
- smoking cessation
sessions, texture
modification sessions,
survivorship study days
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Clinics at other
outreach locations
Implementation of
AHP clinics
Evolving roles
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And…?
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Thank you - Any Questions?
Contact details:
rsc-tr.MarsTeam@nhs.net
01483 408379
Claire Hanika – Macmillan Dietitian
Anna Clayton – Macmillan Dietitian
Kate Edwards – Macmillan Speech and Language Therapist
Emma Papworth – Macmillan Nutrition Nurse
Elizabeth Seymour – Macmillan Care Co-ordinator