Frede Olesen Professor, DrMedSc, GP, FRCGP(hon.) The Research Unit for General Practice, Aarhus University Chairman of the board of The Danish Cancer Society FO@alm.au.dk
Denmark - City of Aarhus
A Danish national cancer rehabilitation initiative
– A case story needs needs – A case story • Operated cavity cancer by radiation and chemotherapy • Difficulty for oral followed in opening the without teeth • mouth and No saliva, • Eating problems – can impaired speech food severe weight only eat soft , loss • Low • Fatique physical • Social isolation, loss of job • functioning Later – severe depression and marriage severe depression and broken broken marriage
Good chronic care: needs are different at different times and often mixed. Late effects/psychsocial needs Different focuspoints: Discharge Treatment Follow-up appointment A: - Somatic – social – psychological functioning B: - close to end of treatment reestablish normal functioning - follow up plans – are they evidence based - life has Different focuspoints A: - Somatic – social – psychological late
A structure with 3 key stakeholders - Denmark 5.5 mill inhab Five Five regions running Municipalites some General practice settings N = 2200/3500 GPs
A national cancer plan for rehabilitation Third national cancer plan • Integrated clinical pathways for rehabililitation from hospital to primary care should be implemented • The cancer survivor should be given a survivorship plan at discharge or when relevant. The plan will be generic for the diagnosis
A national cancer plan for rehabilitation A national cancer plan for Third national cancer plan national cancer plan • All cancer survivors should be screened effects and at and at and given appropriate treatment • Valid screening tolls should implemented • National clinical guidelines for be rehabilitation, late effects and controls be developed • late effects Controls screening for cancer as well as recurrence of screening for late effects as well as recurrence of cancer
What happens now?? money • Most ressources will be allocated municipalities to the programs • Implementation through 2012 and local supplemented with clinical guidelines • Some money for implementation • Most ressources will be allocated to the municipalities • Implementation through 2012 and local programs ready by the end of 2012
rehabilitation and palliative care clinical pathway for cancer rehabilitation and palliative care • Rehabilitation should address physical training as well as psychological, social and existential needs programs for cancer patients by the end of related • rehabilitation • Rehabilitation and palliative care are seen as a continuum of care • Rehabilitation should address physical training as well as psychological, social and existential needs • The hospitals and family doctors have an important role in identifying rehabilitation needs and referral to municipality based rehabilitation • The municipalities must establish rehabilitation programs for cancer patients by the end of 2012
members The national patients organisation with some 500.000 members and a large funding agency
Patients voice Patients Collectring documentation for need Creating evidence Money for R&D Setting the political and prof. agenda Political lobbyism
Needs assesment is essential The Danish Cancer Society model for graduation of efforts Highly complex rehabilitation needs 5% Rehabilitation and late effects 25% requiring a specialized effort Supported self-care or limited 70% needs
A pathway programme for cancer rehabilitation -inspired by cardiologic rehabilitation Partners throughout the three phases of cancer rehabilitation Phase II Phase III Phase I Early follow-up Follow-up and maintenance Primary contact Weeks to months Months to years Days/weeks Treating ward/oncological ward: Municipal rehabilitation Treating ward Diagnosis specific rehabilitation programme (Physiotherapist, dietician, social worker, etc.) Physiotherapy (lymphoedema) Late effects unit Psychologist Psychologist Municipal offers Patient training, e.g. Stanford programme Physical training programme General practitioner The Danish Cancer Society’s counselling Patient school The Danish Cancer Society’s counselling centre The Danish Cancer Society’s centre counselling centre Hospital, municipality, General practitioner and Hospital General practitioner municipality
Thank you for your attention I look forward to further inspiration from you FO@alm.au.dk
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