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Case History

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Image not available. Patient 1.

A 56-year-old man was admitted to the emergency department (ED) with seizures following a fall. At the time he was on chemotherapy for small cell lung cancer with metastases in bone, liver and brain. He was complaining of severe pain in his hip; a subsequent radiograph showed a fractured pelvis. The acute cancer team were paged and asked for advice. A senior nurse and a consultant medical oncologist attended the emergency department.

Patient 2.

A 79-year-old woman was admitted to the emergency department (ED) with abdominal pain. She had cancer of unknown primary and was beyond the active management phase of her cancer journey. The acute cancer team were contacted for advice by pager.

Patient 3.

A 77-year-old man received his third cycle of docetaxel chemotherapy for metastatic carcinoma of the prostate and felt unwell two days later over the weekend. He did not use the 24-hour contact line, but instead telephoned the out-of-hours general practitioner (GP) who gave him oral antibiotics. On Monday morning his family made use of the contact line to telephone the day unit, and were advised by nursing staff to bring him in for urgent assessment. He arrived within 40 minutes of the call.

How were the patients managed?

How has the long-term presence of a resident oncology team promoted acute oncology care?

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Background

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Image not available. Cancer care in Airedale Hospital has been provided by resident consultant oncologists and an oncology team for many years. This contrasts with historical arrangements in acute general hospitals (AGHs), where specialist oncology services were largely provided by doctors based in tertiary centres who visited AGHs. It therefore gives us the opportunity to evaluate the impact of this arrangement on acute oncology practice over a lengthy time period.1,2 The Airedale oncology service came about because in the late 1980s a local cancer research charity, which was seeking to enhance its clinical role, funded a medical oncologist in the hospital. The current oncology team includes two consultants and a trained associate specialist, plus two other specialty doctors employed by Airedale. This team works with four consultants and an associate specialist who are based in the neighbouring Bradford Teaching Hospitals Foundation Trust where the designated inpatient service is located, although most local patients are admitted to Airedale. This arrangement permits a high level of cancer site specialization.

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How were the patients managed?

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Patient 1 had had a recent CT scan which showed progressive disease, and the patient was due in the outpatient clinic that week for a consultation on the findings, so a decision to discontinue treatment was discussed with the patient in the emergency department. As a surgical approach was not appropriate, this discussion centred on specialist palliative care management. The palliative care team within the hospital was contacted (the community team were already supporting the family at home) and a placement was found for ...

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