Cancer Care Review:
A little more detail
What
Cancer Care Reviews involve a person living with cancer having a conversation with a primary care healthcare professional about their needs in order to ‘raise any issues relating to their cancer or treatment that are impacting on their quality of life or wellbeing’.
As previously stated, holistic needs for many people do not stay static from diagnosis, through and beyond treatment, and they may change significantly at different times in the pathway. To support people in the best possible way, ongoing, open conversations to identify and address changing holistic needs should be recognised as integral to person-centred care. Cancer Care Reviews offer a formal and structured way to have these types of conversations post treatment.
The Cancer Care Review incorporates both a clinical and non-clinical assessment of needs post treatment within primary care. The purpose of the Cancer Care Review is to identify the person’s holistic needs and to reassess the effect of cancer and its treatment on the totality of the person. It has a focus on all aspects of their life as they transition from treatment to follow-up and from secondary care to primary care.
As such, the initial Cancer Care Review conversation may have a focus on holistic needs, but consequences of treatment and symptoms of recurrence should also be discussed.
As with the HNA and Care Planning, an effective Cancer Care Review must involve a high-quality conversation which focuses on what matters most to the person with cancer at that time and it must give them an opportunity to discuss and explore any issues raised. The intensity and depth of the conversation will vary according to the individual’s changing holistic needs, their circumstances, and their treatment history.
As previously stated in the Treatment Summary section, ideally the initial Cancer Care Review should be informed by the Treatment Summary (or equivalent).
A Cancer Care Review should include a review of:
- the person’s diagnosis and past treatments,
- previously documented conversations about identified needs, eg, referring to HNAs and care plans (if necessary and available)
- plans and actions to address needs, eg, referring to the care plan (if necessary and available)
- what the person can do, such as adopt healthy lifestyle changes, and what support is needed to do it.
A Cancer Care Review is a thorough review of the above. There may be no more actions necessary, however new unmet needs may arise, and these should be addressed through subsequent HNAs and Care Planning.
When
Guidance on when to conduct a Cancer Care Review varies, but it is generally between six and 12 months after diagnosis. Ideally, a person’s first Cancer Care Review appointment should take place when the person needs it, which can be prior to the end of treatment, or soon after. Timings will vary considerably depending on the person and their circumstances. However, offering a Cancer Care Review within six months of the end of treatment is a good general guideline. It is therefore problematic if a Treatment Summary (or equivalent) is provided or presented late.
There are examples of good practice of possible timings for a Cancer Care Review.
For example, a Cancer Care Review can start with a phone call from primary care to the person shortly after diagnosis. This would be to check in with them and establish or develop the relationship. Also, this can be an appropriate time to identify concerns and check the person’s understanding of their treatment.
This can then be followed by a dedicated appointment when active treatment is coming to an end or has finished.
Some areas in the UK have now implemented annual reviews in line with other long-term conditions, ensuring that cancer-specific areas are addressed while recognising that cancer shares aspects with other long-term conditions and patients prefer holistically delivered care reviews and Care Planning as opposed to a ‘disease silo’ approach.
As with HNAs and Care Planning, the Cancer Care Review is not a one-off post treatment review. Cancer Care Reviews should be carried out as appropriate to monitor and address changing holistic needs, particularly as longer-term consequences of cancer or treatment emerge. The frequency of subsequent Cancer Care Review appointments can be planned at the initial Cancer Care Review, based on the issues and unmet needs identified.
Who does it and where
Cancer Care Reviews can be conducted by any healthcare professional working in primary care. Access to a person’s Treatment Summary (or equivalent) and previous HNAs and care plans support a Cancer Care Review. Although, in practice, Cancer Care Reviews do take place without all this information.
Those professionals that facilitate the Cancer Care Review should have the capability to support the person to explore their needs and ways of ensuring that they can be met. Although the Cancer Care Reviews are predominantly coordinated within primary care, the holistic aspects of the review can be undertaken by professionals that sit in other settings, eg, in community settings. Macmillan advises that a Cancer Care Review should be a face-to-face conversation.
The same definition that was used in the HNA and Care Planning sections can be used for the Cancer Care Review:
It is a structured, person-centred conversation, interaction or dialogue, in real time, between a person who has cancer and the relevant professional. That professional can be registered or unregistered but they must have the capability and skills to support the person to identify their holistic needs, prioritise them, and facilitate addressing those needs.
Common challenges expressed when discussing implementing Cancer Care Reviews:
“There is inadequate information being received from Secondary Care e.g. Holistic Needs Assessment / Treatment Summary”
Communicating with Secondary Care – suggest working with one specific tumour site initially as a pilot (start small!)
“We don’t have enough resources (time and GP or nurse capacity) to do a Cancer Care Review”
It could be incorporated into a LTC Review / could be flagged on the system for when it is due
“We don’t know who should complete a Cancer Care Review”
“I’m not sure what a Cancer Care Reviews is!!!”
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