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Development of acute oncology services

The National Chemotherapy Advisory Group was established to advise the National Cancer Director and the Department of Health on the development and delivery of high-quality chemotherapy services. In 2009 it published a report recommending the development of acute oncology services to address the concerns raised in the 2008 National Confidential Enquiry into Patient Outcome and Death.1,2 The enquiry had raised concerns in a number of areas about the care of cancer patients. Specifically, in regard to deaths within 30 days of receiving systemic anticancer therapy (SACT), the enquiry reported that in only 35% of patients who died within 30 days of receiving SACT was their care judged to be good. There was room for improvement in the care provided to 49% of patients, and in 8% of cases the care provided was less than satisfactory. Alarmingly, in 27% (115/429) of cases, the enquiry found that SACT had caused or hastened death. Furthermore, it highlighted the fact that many patients received SACT in specialist cancer centres but ultimately were admitted with complications of cancer treatment to their local hospital. It was found that 42% of all unwell cancer patients were admitted under general medicine rather than to a specialist oncology ward, yet 43% had grade 3 or 4 SACT-related toxicity on admission; 15% of patients were not admitted to the centre where their SACT had been administered.

The subsequent 2009 National Chemotherapy Advisory Group report gave a number of recommendations to improve patient care and safety and described the need for acute oncology services: ‘Acute oncology encompasses both the management of patients who develop severe complications following chemotherapy or as a consequence of their previously diagnosed cancer, as well as the management of patients who present as emergencies with previously undiagnosed cancer. Acute oncology therefore necessarily involves clinicians working in emergency departments and in acute medicine, as well as in oncology and related disciplines.’2 The recommendations included the principles that all hospitals with emergency departments should establish an acute oncology service, the service should develop local policies and procedures for the treatment of cancer patients, there should be appropriate training for clinical staff in the identification and management of acute oncology presentations and there should be access to urgent specialist oncological advice on the care of cancer patients admitted as an emergency.

New national peer review measures reflected the National Chemotherapy Advisory Group recommendations and focused on the timely review of patients admitted as an emergency to hospital by a member of the acute oncology team and oncology consultant, the 1 h door-to-needle time for the treatment of neutropenic sepsis, timely investigation and management of metastatic spinal cord compression (MSCC), and development and training in acute oncology emergencies, at that time totalling 22 defined emergencies ranging from hypercalcaemia to pleural effusion and chemotherapy-related diarrhoea.3 These priorities, with specific targets to aim for and monitor, were reinforced by a ...

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