Key is identifying those in need of extra help
NO matter what your age or previous state of health, a cancer diagnosis can be terrifying and the start of a long, hard battle.
However, for those who are already frail or receiving other treatment, the fight can be even more complicated and difficult.
The new Christie at Macclesfield centre will open at the end of the year and here consultant clinical oncologist Doctor Victoria Lavin talks about what measures are already being taken to identify and provide the support patients will need.
Cheshire East has a population that is older than the country’s average, so Dr Lavin says: “We need to identify the patients who are most at risk and most likely to benefit from some extra help.
“This is all about finding small ways to make cancer treatment better and easier to cope with for patients with frailty.”
With around four months to go until opening, here is where this work is up to.
“Striving to improve patient services is in our DNA at The Christie and having already developed local radiotherapy treatment centres in Oldham and Salford, we wanted to make the new Macclesfield cancer centre our best yet.
From very early in the process of developing plans for the Christie at Macclesfield we wanted to ensure that the new cancer centre was able to cater more effectively for the needs of patients with frailty.
At present, 23 per cent of Cheshire East’s population are over the age of 65 - against the UK average of 18.5 per cent, and this is set to rise to 30.2 per cent by 2040, with 5.6 per cent of people in the area expected to be over 85 by 2043.
Of course, plenty of over65s are very fit, but we are also very mindful that frailty issues, particularly among older people, can have a big impact on the success or otherwise of cancer treatment.
In particular, patients with frailty are less likely to complete all their planned cancer treatment and are more likely to have problems with side effects - often requiring hospital stays.
Frailty is marked by a physiological decline and is often characterised by an increased vulnerability to adverse health outcomes.
An ageing population requires a fundamental shift in the way that cancer care is delivered.
There are around 363,000 new cancer cases each year in the UK, with more than a third of these cases being linked to people over the age of 75.
The burden of having cancer and the impact of sometimes gruelling cancer treatments such as chemotherapy and radiotherapy on patients with frailty can affect them physiologically as well as impacting their survival, mortality and quality of life.
So we need to identify the patients who are most at risk and most likely to benefit from some extra help.
At our Withington site, the Christie has already been pioneering frailty assessments for cancer patients with lung cancer and those having gynaecological cancer surgery.
These allow us to provide a holistic approach to patient needs and help us to identify interventions that improve the quality of care.
And more recently, at the outpatient clinics we hold at Macclesfield District General Hospital, we’ve been identifying the patients with frailty who are most at risk.
New patients referred to us for lung, breast or bowel cancer treatment are assessed by the consultant using something called the Rockwood Clinical Frailty Scale.
Any patients who we feel might benefit from additional support are then asked to complete a more detailed survey focusing on specific areas where that patient may need help.
These include physical, psychological, social and practical support.
We have been trailing the use of this frailty questionnaire in the colorectal cancer clinics for the last few months and this is a practice we will take forward into the Christie at Macclesfield once it opens later this year.
The work we have done so far has given us a good understanding of how many people may need extra support and what kind of support they would need.
In the 12 months between February 2020 and February 2021, we identified around 56 patients out of 251 who would potentially need support.
One area we will be focusing on is the number of medications that a patient might already be on and how the different medications may be interacting with each other.
Where we feel there is a risk, our Christie pharmacy team will be asked to advise so that the medications a patient is taking do not adversely impact their cancer treatment.
Other areas where we think some patients might need extra help include physiotherapy, occupational therapy and advice from a dietician.
Clinicians at the Christie hope to work closely with the existing, highly rated inpatient frailty team at Macclesfield District General hospital and with community-based health and care services to access these services for cancer patients with frailty.
We hope that by putting extra measures in place, more patients will choose to have cancer treatment rather than declining it and that more of the patients who start their treatment will get to the end of the treatment rather than feeling like it is too tough on them.
This is all about finding small ways to make cancer treatment better and easier to cope with for patients with frailty.
We also hope that by supporting patients earlier on in their cancer treatment we will be able to reduce emergency hospital admissions which are very distressing for patients and their families.
By the time the new cancer centre is open at the Christie at Macclesfield we are aiming to have identified the services across Cheshire that we will need to help patients access.
Having cancer at any age is hugely challenging, but for patients who are already vulnerable in some way, the prospect of going through what can be arduous treatments is frightening.
Anything at all, no matter how small, that we can do to help them makes a big difference.
I am confident that the steps we are taking now will make a difference to patients with frailty who come to the Christie at Macclesfield.”