A better approach to aftercare for patients who have had breast cancer

More people than ever before are surviving cancer, but at the same time incidence of cancer is increasing. By 2030, the number of people living with cancer in Scotland is expected to rise from 220,000 to 360,000.

As a result, health services need to consider how care and support is delivered after treatment is complete to ensure that the best possible care and support is provided to this group of patients.

At Stobhill Hospital in Glasgow we have been trialling a new approach to supporting people after breast cancer treatment as part of the Transforming Care After Treatment (TCAT) programme, funded by Macmillan Cancer Support.

Currently we see about 300 new breast cancer patients every year and have over 2,000 patients in follow-up for breast cancer.

Prior to the pilot, women who had finished breast cancer treatment attended an annual mammogram and had a five to ten-minute appointment with a doctor working in the breast team. This short appointment didn’t give us enough time to assess the patients well. It also offered a poor experience for patients, who were given a very brief clinical examination before being hurried down for their mammographic follow-up.

A majority of breast cancer follow-up patients do not need to be seen by a doctor or a consultant surgeon but some of them tend to store up all their concerns for their annual appointment only to find when they arrive, that we have a very brief time to talk to them and can’t address a lot of the concerns they have. In reality, a lot of these concerns aren’t medical concerns and the consultant isn’t the best person to address them anyway.

The aim of this project has been to move away from routine follow up, where one size fits all, to more individually tailored aftercare arrangements based on self-care or shared care, with clinical follow up available when required.

When attending their annual mammogram, instead of an automatic consultant appointment, follow-up breast cancer patients are offered a holistic needs assessment (HNA).

The information provided as part of this assessment is then reviewed by a Clinical Nurse Specialist who, following a discussion with the patient, creates an individual care plan and helps them access the most appropriate support services for them.

The new model of care has proved very effective in being able to address patients’ problems quicker and in a better manner, with more people being referred onto emotional, financial and practical support services and to NHS clinics for help managing side effects. If they do have medical concerns, they are able to contact a member of my team at their discretion and their problems will be addressed at that time.

We have seen a 50 per cent reduction in demand for follow-up appointments, allowing us to spend more time with patients with complex issues.

This was the first project to be implemented in the West of Scotland looking at follow-up in breast carcinoma and initially there were concerns both from the patients and my colleagues about how this would be implemented and what the reception would be.

In fact, the results have been extremely positive on both fronts. Our feedback from the patients has generally been extremely positive. They have been pleased with the new model of care and the evidence we have collated from the project has shown very good results.

Likewise, my colleagues have taken this on board. We are now rolling the programme out to everyone who has finished treatment for breast cancer in Stobhill and it is being embedded into everyday practice. We are also looking at implementing it on a wider basis across all of the West of Scotland area.

This pilot adds to a growing body of evidence from across the UK, showing that when people are offered care after treatment built around an individual assessment of their needs, it results in a better patient experience.

The reduction in consultant appointments also indicates that this approach leads to better use of NHS resources and we hope decision-makers across the NHS in Scotland will look at the results of our project and consider how its lessons can be used to improve care after treatment in this country.

Keith Ogston, consultant surgeon at Stobhill Hospital, Glasgow