This new guidance comes from a partnership between the London Strategic Clinical Network for Mental Health and the Transforming Cancer Services Team for London.  The report opens with a powerful account from a cancer patient, sharing with us the impact cancer has had across all aspects of his life, demonstrating very clearly why a more holistic view of cancer outcomes, beyond survivorship, is needed.

The guidance encourages commissioners and providers to consider the emotional and psychological consequences of cancer and has been timed to inform commissioning intentions for 2016/17.

Method

The guidance is based on:

• a mapping of current service provision in London;
• a review of the evidence base;
• consultation with patients, commissioners and providers.

Findings

The guidance suggests that around three quarters of cancer patients need access to psychological support, pointing to evidence showing the different this can make to quality of life, health outcomes and future healthcare costs.

However, the teams found significant variation and fragmentation across current service provision, meaning that patients, their carers and families are getting inconsistent and inadequate support throughout the cancer pathway.

Evidence gathered for the report suggests that 25% of people diagnosed with cancer report anxiety and depression, which impacts their day to day life within the first year of their diagnosis. Further evidence from Macmillan Cancer Support suggests that 60% of cancer patients who consider themselves to be depressed don’t receive support.

Aside from the obvious impact on quality of life, this lack of support can influence other health outcomes, including: adherence to medication, longer lengths of stay and potential risk of suicide.

 

Ten recommendations outline actions commissioners and providers can take to improve care for patients, their carers and their families, which focus on:

• improved access to a range of support services across the pathway;
• access to support services for carers and patients’ families as well as patients themselves;
• holistic needs assessment and care planning to address current fragmentation;
• community provision of support services;
• on-site support at cancer centres;
• co-production with patients and the public in decisions about service provision and design.

Whilst the guidance is focused on support for adults, the authors suggest the same principles could apply to care for children and adolescents although the pathways differ. The authors also suggest the same principles could apply to support for people with long term conditions.

The guidance includes some useful tools:

• a commissioning model, which sets out the roles and responsibilities of primary care, secondary care and third sector providers;
• information on education and training tools;
• a series of case studies;
• reference to the Macmillan Cancer Support recovery package;
• patient stories collected during consultation;
• a holistic health needs assessment template.

Commentary

Whilst the guidance is focused on London, it provides a comprehensive account which will resonate in other communities. The report is based on a systematic process of information gathering and consultation, sharing not only findings but useful tools, which other commissioners and providers will find useful.

The guidance raises some important questions for commissioners, which include:

• What is your model for commissioning support services?
• What support services are currently commissioned and what do they offer to patients, carers and families?
• Where are the gaps in service provision?
• What are the experiences of patients and carers using these services?
• How are you involving patients and the public in decisions about future provision?
• How can relationships between the various services involved in delivering care and support be improved to better support patients, carers and families?
• What information is needed by patients, carers and families who need to access support services?
• What information is currently available and what needs to be improved?

Link

London Strategic Clinical Networks and Transforming Cancer Services Team for London (2015) Psychological support for people living with cancer: commissioning guidance for cancer care in London, London Strategic Clinical Networks. [PDF]