Driving Innovation Into Business As Usual

Below is a summary of the five successful projects in this year's West Yorkshire and Harrogate Cancer Alliance Innovations Bursary Fund.

Airedale, Wharfedale and Craven - Modality Primary Care Network

• Promote and deliver cancer screening services in the community and improve uptake of cancer screening services to diagnose cancers at an earlier stage 

Currently, patients from ethnic minority communities from the Wharfedale and Craven Primary Care Network are less likely to undergo cervical, breast and bowel screening, meaning that cancers are often diagnosed much later or missed completely due to lack of or late presentation to cancer services.

Working locally with a partner in the community - Keighley Asian Womens and Childrens Centre (KAWACC) - the focus in the first instance is on Asian women who are not taking up their cervical screening, with the project then focusing on breast and bowel screening within the Asian population. One key benefit of working with a local community parter is that they can shape and tailor the messaging for the local population, as well as providing peer to peer support for patients locally.

From pilot evidence initially collected in the population and working in association with KAWACC, the plan is to:

• Increase awareness
• Develop information Leaflets and posters in different languages
• Offer appointments outside of the 9am to 5pm work pattern, providing increased flexibility
• Run clinics and health promotion advice from local community settings to increase uptake
• Work with and be led by community partners

Benefits to patients include flexible clinic times, opportunity to receive earlier diagnosis and treatment, crucially resulting in better outcomes and patient experience.

Airedale General Hospital NHS Trust

• Improving patient experience post breast cancer diagnosis with less invasive procedures

Currently, patients who have had a diagnosis of breast cancer will as part of preparation for their breast surgery will have what is known as wire localisation. This is a when a small wire, similar in diameter to fishing wire will be used to indicate which part of the breast is cancerous showing the surgeon which area to remove, which will be done later that day or the next day.

This process can be stressful to the patient as the process is often painful, adding an extra hospital visit, impacting overall patient experience and can in 25% of cases lead to a second surgery having to be performed due to the wire having moved / dislodged.

Magseed, is a wire free alternative. A small non-radioactive seed, smaller than a grain of rice is designed to accurately mark the site of a cancer. It can be placed days, weeks or months ahead of surgery to suit the patients and the surgical teams, which can be done in 5 -  10 minutes. The Magseed can be found again using a Sentimag Probe. Magseed is clinically proven to be safe, accurate, effective treatment and is used in countries around the world.

Magseed is less invasive, improving the patient experience, reducing patient visits and reducing the likelihood of a second surgery having to be performed from around 25% to around 6.5%.

Bradford Teaching Hospitals NHS Trust

• Magseed wire free alternative improves breast cancer patient experience

Currently, patients who have had a diagnosis of breast cancer will as part of preparation for their breast surgery will have what is known as wire localisation. This is a when a small wire, similar in diameter to fishing wire will be used to indicate which part of the breast is cancerous showing the surgeon which area to remove, which will be done later that day or the next day.

This process can be stressful to the patient as the process is often painful, adding an extra hospital visit, impacting overall patient experience and can in 25% of cases lead to a second surgery having to be performed due to the wire having moved/dislodged.

Magseed is a wire free alternative. A small non-radioactive seed, smaller than a grain of rice, is designed to accurately mark the site of a cancer. It can be placed days, weeks or months ahead of surgery to suit the patients and the surgical teams. This takes just 5-10 minutes. The Magseed can be found again using a Sentimag Probe. Magseed is clinically proven to be safe, accurate and effective and is used in countries around the world. It is less invasive, improving the patient experience, reducing patient visits and reducing the likelihood of a second surgery having to be performed from around 25% to around 6.5%.​​​​​​​​​​​​​

Leeds Teaching Hospitals NHS Trust

• Oncogeriatric Clinic - early diagnosis and optimisation of frail older patients

Currently, older patients who have underlying co-morbidities with complex needs (e.g. lacking mental capacity, dementia, frailty, falls or general vague symptoms) are often misdiagnosed when it comes to cancer. Also they are often diagnosed late or if too frail, have unnecessary tests/treatments which result in significant psychological and physical distress, both for the patient and family. This recognition has prompted a pilot project to identify and streamline a pathway that puts the patient at the centre of all decision-making, using the principles of comprehensive geriatric assessment.

Through completion of two pilot projects, the team in Leeds wish to deliver two main services:

• A bespoke clinic for older patients, where frail older patients with a suspected gastrointestinal diagnosis of cancer will be assessed
• A perioperative medicine clinic that will optimise and/or discuss alternative types of treatment in high-risk frail older patients with a confirmed diagnosis of gastrointestinal cancer, through a multidisciplinary approach with surgeons and anaesthetists

Patients will benefit in a number of ways. The service will help enhance clinical decision-making early in the patients suspected cancer journey, and ensure appropriate tests are ruled in or ruled out, allowing an effective risk stratification process of the patient. This will subsequently lead to effective workflow management and most importantly, a better experience for the patient and their family. This bid will also enable the training of all clinical nurse specialists to assess patients for frailty in an outpatient oncology setting.

The services above will help patients in a number of ways. Patients will receive a frailty Holistic Needs Assessment (HNA) to empower them in shared-decision making around their care. Secondly, patients who are planned to have surgery in relation to gastrointestinal cancer will have frailty risk assessments, as well as targeted interventions and alternative treatments, based on individual need.

For more information about this project, contact Sherena Nair (Elderly Medicine and Perioperative Care Consultant)

Email: sherenanair@nhs.net or call Denise Donaghey, Secretary, on 0113 206 4133

 

Mid Yorkshire Hospitals NHS Trust

• FEES (Fibre-optic Endoscopic Evaluation of Swallowing) - a direct view of the larynx and upper airway for head and neck cancer patients

​​​​​​​Head and neck cancer patients often suffer challenges regarding eating and drinking after treatment. Swallowing problems (dysphagia) mean that food or drink sometimes goes into the lungs (aspiration) which can cause chest infections leading to pneumonia, affecting patient recovery, experience and quality of life.

Fibre-optic Endoscopic Evaluation of Swallowing (FEES), carried out by speech and language therapists, is an essential instrumental assessment which improves patient experience. A flexible cable with a camera attached is passed  through the nose to see the structures of the throat, allowing examination of the  function of the patient's swallow in real time, enabling more accurate diagnosis of the problem and guiding rehabilitation.  

Benefits of this are numerous. For example, it gives immediate feedback to both patient and speech therapist. The FEES assessment can be done at the patient's bedside and it can be used with a range of patients with different complaints - for example head & neck cancer, stroke, neurological issues. It allows for a personalised rehabilitation plan based on the assessment.

For information about this project, contact Nina Corfield, Highly Specialist Speech and Language Therapist

Email: nina.corfield1@nhs.net

Direct line: 01924 542544 or call Dawn Coomber, Secretary, on 01924 543873