The Sheffield Transformational
survivorship project
NCSI - drivers
Cancer Reform Strategy
2007
Increasing
survivors
Unmet
needs
Finite
resources
National Cancer Survivorship
Initiative 2008
• Breast
• Colorectal
• Prostate
Revised pathway (NTCN 2011)
Old
 ‘One size fits all approach’
 CEA 3/12 (2yrs) 6/12 (3yrs)
CT 9 and 24 months
Colonoscopy
New
 Clinical components
same
 OPA frequency
reduced
 OPA 3/12 (2yrs) 6/12 (3 yrs.)
 5 years secondary care led
 Transfer of care to PC
Diagnosis &
Treatment
Recovery
Early
monitoring
Later
monitoring
What happens here?
Progressive
illness
End of life
care
Cancer survivor
Wider population
90%
45%
20%
68%
15%
11%
25%
9%
29%
9%
59%
27%
16%
18%
16%
13%
2%
4%
4%
2%
Use of the NHS past 12
months:
 Primary Care
 Specialist doctor
 A+E
Impact on work and
relationships
 Prevented by health from
working in preferred
occupation
 Health interferes in
relationship with partner
Difficulty/ inability in
undertaking different activities:
 Vigorous activities (running/
sports)
 Housework, shopping,
cooking
 Going out
 Social activities
 Personal care
Macmillan Health and Well Being Survey 2008
Where we think people are….
Is not necessarily the case…
New Colorectal Pathway 2011
6m
CEA
Cancer
Care
Review
12m
CEA
15m
OPA
+
CEA
18m
CEA
21m
CEA
24m
OPA
CT result
CEA
Colonoscopy 5 yrly
9m
OPA
CT result
CEA
CT
Colonoscopy
3m
OPA
+
CEA
Colonoscopy
HNA + Care Plan
6/52
OPA
+
CEA
CT
Risk Stratification
HNA
colon
Health and well-being event
HNA
review
Treatment
Summary
Level 1
CEA 6 m
6m
OPA
for 1 yr.
CEA
HNA
rectal
Level 2
CEA 6 m
+
Review
NCSI
‘immediate
benefit to
patient
experience and
quality of care
along the
pathway’
Project work-streams
HNA and Care Planning
Treatment Summaries
Health and Well-being programme
Cancer Care Review
1-2-1 support pilot
Risk stratified pathways
Remote Monitoring
Workforce Education and development
Rehabilitation
> Working through cancer
> Let’s get moving pathway
A complete picture
Revised follow up
pathway
Locally commissioned
scheme
The Recovery Package
Self-management
Clinical effectiveness
Cost benefit analysis - colorectal
• Forecast No. of potential eligible patients per year = 450
• Old pathway (visit) > 2 x OPA per yr. @ £72 each = £64,800
• 70% Level 1 = 315 > 2 x CEA per yr. @ £18 each = £11,340
• 25% Level 2 =112.5 > 2 x CEA per yr. @ £18 each = £4,050
+ 1 x review per yr. @ 41 each = £4,612
Total under scheme = £20,002
Saving per year = £44,798