The National Chemotherapy Advisory Group (NCAG) report in 2009 outlined a number of recommendations aimed at improving the safety and quality of chemotherapy services in England and Wales. Among these was a statement that all acute trusts with an emergency department should develop an acute oncology service (AOS). A potential model of care was described that included five sessions of consultant oncology time and one full-time equivalent nurse specialist. Thus, the concept of 'acute oncology' was born. From the outset, the emphasis of acute oncology was driven by safety and quality of care for inpatients, although complex service configurations and commissioning have proved to be major challenges. Preliminary surveys in 2011/12 have demonstrated widespread implementation of AOS, with many new initiatives that go beyond the original NCAG model and which illustrate an ever greater potential for service improvement and redesign.1
Acute oncology represents a major shift in the direction of oncology from an ever greater need for subspecialties and personalized medicine back towards a need to deliver unplanned oncology care using basic cross-cutting principles that are relevant to all cancer patients. Evidence, albeit largely anecdotal, suggests that acute oncology has been warmly welcomed by NHS trusts and general medical colleagues, and is leading not only to improved care and coordination, but also to a reduction in length of hospital stay and efficiency savings. It is also important to recognise that acute oncology will affect the way cancer medicine is delivered throughout the world, not just in the UK.
The future challenge of acute oncology remains significant. However, there are also huge opportunities for acute oncology teams (AOTs) to engage with and influence therapeutic strategies that allow the integration of highly specialized cancer treatment alongside local delivery and admission avoidance. In this vision, AOTs will have a leading role to play in service development alongside partner organizations in both secondary and primary care.
Inpatient care has been a major focus for AOTs, but it is clear that future healthcare strategy is towards self-care, early intervention and community-based services. In England and Wales, the NHS Confederation believes that at least 25% of patients in hospital beds could be looked after by NHS staff at home. In this respect, future AOS will need to embrace a wide range of admission avoidance strategies, as illustrated in Figure 11.1
Strategies to avoid admission
Decision making and patient and professional information
Future care will require greater contingency emergency planning, and greater access to information and advice to support patients and professionals; this will enable early detection and management of cancer complications. Developments of existing triage, patient-held records, timely access to summary oncology dashboards and innovation in information technology (e.g. smart-phone applications, or 'apps') will all improve opportunities to ...