Risk Stratified Follow up in colorectal cancer pathways Laura Hope Programme Manager Collaborating to improve cancer care
Introduction Background Collaborating to improve cancer care
Background • Achieving World Class Cancer Outcomes - A Strategy for England 2015-20 • 96 recommendations- Living with and beyond cancer – by 2020 every person with cancer will have be risk stratified to the most appropriate pathway of follow-up care. • Clinically agreed protocols for stratified follow up which are implemented and commissioned by 2020 • Clinical Advice to Cancer Alliances for the Commissioning of the Whole Bowel Cancer Pathway (November 2017) Collaborating to improve cancer care
Guidance • Clinical Advice to Cancer Alliances for the Commissioning of the Whole Bowel Cancer Pathway November 2017 • Inclusion / exclusion criteria • A minimum follow-up schedule – Surveillance and CEA tests – liver and colonoscopy • Treatment summary • Re-entry pathway – Two week response rate to any patients with concerns and possible discussion at MDT.
Stratified Follow up Pathways Collaborating to improve cancer care
Stratified Follow up Pathways Collaborating to improve cancer care
Inclusion / Exclusion Criteria • Low risk tumours (T1-3a N0) treated with surgery alone • Good support and minimal late effects • Moderate risk rectal cancer (T3b-4 or N1-2 or with extra mural lymphovacular invasion) • Patients with stomas, bowel function, and other late effects of treatment • Patients who have not had adjuvant treatment will be followed up by the surgeons • Patient who wish to be followed up Collaborating to improve cancer care
Activity • Regional population of 3.2 million • 2,065 first treatments for colorectal cancers in 2017/18 (source Cancer Waiting Times activity reports). • 100% stratification against protocol • Low risk - 826 patients based on 40% of all colorectal first treatments being eligible • Per Trust who offer colorectal it is between 60 and 110 patient and for tertiary centres 150-175 Collaborating to improve cancer care
Next Steps • Protocol • Share clinical guidelines • Follow up in primary care • Service specification Collaborating to improve cancer care
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