Multi-professional-delivered enhanced supportive care improves quality of life for patients with incurable cancer.

BACKGROUND:: Enhanced supportive care (ESC) promotes the earlier implementation of supportive care within cancer care. While earlier supportive care has been demonstrated to improve patient outcomes, the model of delivery is variable. The Clatterbridge Cancer Centre has developed a multi-professional delivered model with clinical nurse specialists providing ongoing patient review and care. METHOD:: A retrospective single-system design was used to assess longitudinal changes in Integrated Palliative Care Outcome Scale (IPOS) scores as indicators of quality of life. For other outcomes, a retrospective case control analysis was undertaken. RESULTS:: Statistically significant improvements in all IPOS scores were observed for patients attending ESC. Compared to controls, quantitative outcomes included prolonged survival and reduced chemotherapy-related mortality. Multi-professional delivered ESC successfully improves quality of life and outcomes.

Multidisciplinary supportive care in cancer: cost analysis.

PURPOSE: Enhanced supportive care (ESC) is the early implementation of supportive care in cancer. In England, this model is being developed to support patients with treatable but not curable cancer and implements a multiprofessional approach. OBJECTIVE: To describe the workforce and cost-effectiveness of an outpatient ESC service in a tertiary cancer centre in England. METHODS: Workforce costs to deliver ESC to 265 patients was collected. Service impact on secondary care usage in the last year of life was compared against the regional and national average derived from the National Health Service Digital Secondary Uses Service dataset. RESULTS: Our ESC service required the input of seven professional groups and cost £125 542 for 12 months. ESC patients had an average of 1.72 fewer admissions per patient per last year of life than the national average. Length of stay was reduced from an average of 9.2 days to 4.78 days per admission in the last year of life. The reduced secondary care usage saved £2 398 537.68. CONCLUSIONS: Outpatient ESC in this cohort required an multidisciplinary team approach and saved money through secondary care use reduction.

Incidence of malignancies in heart and/or lung transplant recipients: a single-institution experience.

BACKGROUND: The purpose of this study was to determine the incidence and type of malignancies in heart and/or lung transplant recipients at a single institution in Victoria, Australia, and to compare these findings with the non-transplant general Victorian population. METHODS: Recipients of heart and/or lung transplants at the Alfred Hospital between February 1989 and January 2004 were cross-referenced with the Victorian Cancer Registry. The medical records of all patients with a cancer diagnosis by January 1, 2005 were reviewed. Data were collected on baseline demographics, including cancer type, stage, treatment and survival. Cancer incidence was then compared with rates found in the Victorian population. RESULTS: There were 907 transplants (Tx) conducted between February 1989 and January 1, 2004 on 905 patients, which included 424 heart (HTx), 56 heart-lung (HLTx), 200 single-lung (SLTx), and 227 double-lung (DLTx) procedures. Of these patients, 606 (67%) were male and 299 (33%) were female. Mean age at transplantation was 46.4 years (range 12.6 to 70.4 years). Four hundred twenty-four (47%) deaths have occurred. Median survival for all patients after transplantation was 8.6 years. One hundred two cancers were confirmed, translating to a 7.1-fold increased incidence compared with the non-transplant population. The most common cancer diagnoses were lymphoproliferative disorders (692 per 100,000 person-years), head and neck cancer (336 per 100,000 person-years) and lung cancer (251 per 100,000 person-years). Compared with the non-transplant population this translates into a 26.2-, 21.0- and 9.3-fold increased risk for developing these cancers, respectively, after cardio-pulmonary transplantation. CONCLUSIONS: Certain malignancies are more common after heart and/or lung transplantation. The most predominant in our cohort were lymphoproliferative disorders, head and neck cancer and lung cancer.