Acute oncology services (AOS) are vital for providing consistent and high-quality care for patients, for optimising clinician time and expertise, and for ensuring the best use of NHS resources.
- Meeting the complex needs of acutely presenting oncology patients across a wide variety of clinical contexts is challenging and deserves to benefit from the same strategic and operational clinical leadership that is already available to site-specific cancer teams.
- A clearly defined role for consultant oncologists within acute oncology (AO) is essential for ensuring effective clinical leadership and oversight.
- The rising incidence of cancer in an aging population with multi-morbidity will require a multi-professional approach to care, with AOS providing the critical cancer oversight for the majority of emergency cancer admissions.
The core principles underpinning acute oncology services have been defined as:
‘To promote education, awareness and early access to specialist oncology input, as well as a more integrated way of working between oncology and acute specialties within hospital trusts’.
It can take the form of an in-reach advisory service that underpins cancer care provided by general medicine, or in larger cancer centres an enabler of specific expertise in acute cancer care.
Wherever established across the four nations, AOS are frequently viewed as the glue in the system – supporting patient-centred care and acting as the face of oncology in acute care services. In this respect, acute oncology (AO) has brought myriad benefits to patients, clinicians and the wider system. These benefits can be found through:
- Improved communication
- Timely access to expert advice
- Improved patient experience
- Cost savings through more appropriate use of investigations, early discharge and admission avoidance.
However, the service is still to be fully established to the levels needed for optimum patient care across the UK. Variable funding has led to the development of organic service models with different structures, governance, activities and impact, often without any clear strategic direction. As a result, provision is inconsistent across the country, and sometimes even differs within individual provider organisations.
Planning for the next decade, AO is more relevant than ever. The pressure on urgent care services is unrelenting in the face of a rising cancer incidence in an older and multi-morbid population, and in the context of a greater therapeutic armamentarium with novel and unpredictable toxicity. Furthermore, AOS have played a pivotal role during the COVID-19 pandemic, with a focus on the most vulnerable patients who may require emergency care.
The provision of cancer help lines, timely expert advice and alternative same-day emergency care pathways will increasingly become essential components of future NHS strategy in reducing non-essential face-to-face visits and emergency department presentation for cancer patients.
Underpinning all of this, a refreshed curricula (covering all of oncology) to be rolled out in 2021 incorporates a greater focus on AO competencies. This will arm the future consultant workforce with the formal training required.
Acute oncology: Increasing engagement and visibility in acute care settings
To face the emerging challenge of meeting the needs of acutely presenting cancer patients, the RCR, Royal College of Physicians (RCP) and the Association of Cancer Physicians (ACP) have produced a landmark paper aimed at oncologists, AO teams, trainers, policy makers, trusts and health boards, and of course, patients, to nurture and encourage services across the UK. The RCR will collaborate with the RCP and the ACP to ensure that the recommendations in the report are met.
References
- Read Macmillan's Acute oncology: sharing good practice (PDF) guidance
