Cancer patients need better preparation to access good quality care in a crisis

BMJ 2012; 345 doi: (Published 21 November 2012) Cite this as: BMJ 2012;345:e7932
  1. Zosia Kmietowicz
  1. 1London

More needs to be done to improve the care given to patients with cancer who become acutely ill, a new report concludes.

A joint working party of the Royal College of Physicians and Royal College of Radiologists said that cancer patients who became unexpectedly unwell too often received fragmented care.1 Often they were not told what to expect in terms of their illness and did not know whom to contact when their condition worsened and they needed medical attention. If they did need to be admitted to hospital, they were often seen by several healthcare professionals in many medical specialties and were often given confusing and conflicting advice.

This fragmented care resulted in some patients being treated suboptimally, while others, especially those nearing the end of life, often underwent repeated investigations and interventions that did not benefit them. Some such admissions might have been avoidable, says the report.

The report makes seven recommendations designed to improve the quality of care of this group of patients. These include that oncologists and others who manage patients with cancer should regularly assess potential problems that patients could encounter and to communicate these­­—and plans for how to manage them—to patients and their carers.

Also recommended is round the clock availability of summary information about patients to all healthcare professionals who might encounter them and that patients have a named consultant responsible for their care at all times.

The report provides decision making tools for health professionals working in hospitals and in the community to help improve the care of cancer patients in crisis, and it proposes standards of good practice in each care setting.

It also includes a “planning wallet” to be given to patients to encourage them to talk to their medical team about problems that may arise and to prompt them to seek and keep to hand important information to help manage their future care.

Jane Barrett, president of the Royal College of Radiologists, said, “Patient care and joint decision making must be at the centre of cancer services now and in the future. As clinical oncologists, an important part of our role is to ensure that a patient understands their treatment and is able to decide what is best for them. Cancer treatment cannot be a one sided process. This report gives healthcare professionals recommendations to provide the best care and patients the tools to play an active role in the decisions made about their care.”

Jane Maher, chief medical officer at Macmillan Cancer Support, said, “This report highlights the fact that despite improvements in cancer care in recent years and significant support from the voluntary sector in acute oncology posts and services, there is still work to be done to ensure that patients and their carers know who to go to if their condition suddenly worsens.

“As professionals we underestimate both the importance of preparing people for the possibility of sudden deterioration, particularly near the end of life, and how hard it is for frightened people who are ill to know who to contact. We know much more about the right things to do, but we need to make sure that they happen.”


Cite this as: BMJ 2012;345:e7932