Acute cancer services should be provided in emergency care, says government advisory group

BMJ 2009; 339 doi: (Published 21 August 2009) Cite this as: BMJ 2009;339:b3429
  1. Helen Mooney
  1. 1London

    All hospitals with emergency departments should provide acute cancer services in a bid to improve the quality and safety of chemotherapy for patients with cancer, says a report from a government advisory group.

    The report from the National Chemotherapy Advisory Group is a response to the November 2008 review of the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) (BMJ 2008;237:a2498, doi:10.1136/bmj.a2498).

    The NCEPOD review raised serious concerns about the safety and quality of chemotherapy services in England. Its analysis of the care of patients who died within 30 days of being given systemic chemotherapy showed that in only a third of cases (35%) was care judged to have been good, while in almost half (49%) there was room for improvement. Almost one in 10 patients (8%) had less than satisfactory care, it found.

    The recommendation for acute cancer services in emergency care is intended to ensure not only that patients with cancer receive the correct emergency treatment but also that those with severe side effects as a result of their chemotherapy and patients whose cancer is undiagnosed get prompt and appropriate treatment.

    The provision of acute cancer services was “an innovative idea,” said the chairman of the advisory group, Mike Richards, England’s national clinical director for cancer. They would not be expensive to set up either. “The implementation cost will be neutral overall, because the improved quality of treatment will reduce the number of emergency bed days,” Professor Richards said.

    All chemotherapy patients who access emergency services should also be given antibiotics to combat infection within an hour of coming into hospital, the report says.

    “Much like the clot busting drug [given to] patients who have suffered a heart attack, chemotherapy patients must be given the antibiotics they need within an hour to avoid serious complications,” said Professor Richards.

    The report also recommends clear chemotherapy protocols for hospital staff on issues such as the decision to treat, patients’ consent, prescribing and dispensing, and information for patients and carers. And it calls for a new framework for commissioning, delivering, and monitoring chemotherapy services.

    The number of NHS patients receiving chemotherapy has risen by 60% in the past four years, but Professor Richards acknowledges that the quality and safety of chemotherapy needed to be improved. “This new guidance will help all hospitals [do this], and I urgently ask them to adopt these guidelines,” he said.

    Commenting on the report the health minister Ann Keen said that cancer treatment in England had improved vastly. “The challenge now is to keep up this momentum,” she said.


    Cite this as: BMJ 2009;339:b3429


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