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In the UK, one in two people over 40 will get cancer at some point in their life.1 Treatments are continuously improving, meaning more people are living with cancer or living with the consequences of cancer and/or its treatment. Cancer has increasingly become, for many, a chronic disease. However, unlike other chronic diseases, such as diabetes or hypertension, which are almost wholly managed in the community, cancer is still seen very much as the domain of ‘cancer specialists’ who work in the acute sector. As a result, community healthcare professionals often do not feel as confident in assessing patients living with cancer as they do in assessing patients with other chronic diseases.

People living with and beyond cancer usually want to get on with their lives after treatment is complete. We therefore have a duty to spot any problems at the earliest juncture and treat them outside the hospital environment wherever possible. If they do require urgent specialist assessment, it is important to recognize the problem quickly and ensure that appropriate emergency assessment happens in a timely way.

Here we describe three services in the UK that are providing treatment for unwell cancer patients outside the acute setting and that are exploring innovative ways to support these patients.

A community acute oncology service: supporting patients and developing the skills of those in primary care

The Mid Cheshire Hospitals NHS Foundation Trust in Crewe has had an acute oncology team since 2012. It is a district general hospital serving a rural population of 275,000. The hospital is served by visiting oncologists from nearby tertiary referral centres including the Christie Hospital in Manchester, located 30 miles (48 km) away.

In 2015, the trust, Vale Royal and South Cheshire clinical commissioning groups, together with Macmillan Cancer Support, funded a new role of a community acute oncology nurse. The remit of this role was twofold: to assess potential pathways to support and manage oncology patients outside the traditional model of hospital care where appropriate; and to propose strategies to educate colleagues working in the community on cancer and its treatment and how to identify and manage the acutely unwell cancer patient.

Since the start of the post, the acute oncology team has become more outward-facing, frequently taking calls from GPs and other community professionals to give advice and discuss cases. They will review patients at home if necessary or within a primary care setting and have developed good relationships with other hospital-based colleagues. With improved collaboration between the two sectors, urgent review in a specific patient-appropriate setting (e.g. ambulatory care ward, outpatient clinic or urgent care centre) is now possible. The community acute oncology nurse also acknowledges peer education as a large part of the role and has developed many educational materials for use with colleagues working in the community including a top tips ...

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