Julie Want and Yuki Kano: Enhanced Supportive Care at the Royal Marsden NHS Foundation Trust

The aim of our Enhanced Supportive Care Service is to support patients early in their cancer journey and, alongside cancer treatment, by offering proactive symptom control and psychological, social, and practical support.

Since the launch of the Enhanced Supportive Care outpatient service at The Royal Marsden NHS Foundation Trust in 2016 – there have been significant benefits for patients being cared for in our cancer centre.

Our aim is to support patients early in their cancer journey, and alongside cancer treatment, by offering proactive symptom control and psychological, social, and practical support. We do this by being embedded within the oncology outpatient clinic and by working closely with our oncology colleagues. Together, we identify patients who are likely to benefit from early palliative care input. We use a palliative care referral “Triggers” tool to help prioritise patients who are likely to benefit most from our involvement. This is a brief checklist of items that might indicate that the patient has symptoms or other issues with which we can help. We also use validated patient reported outcome measures (Integrated Palliative Outcome Scale, IPOS) to ensure that the care we provide is centred around the needs of each individual patient.

We have collected robust service level data as well as qualitative feedback from staff and patients, and we have been delighted with the outcomes that showed the positive impact of our service. Since we launched our novel “Triggers” service, we have been at the forefront of delivering Enhanced Supportive Care, and we have presented our work at national and international level.

One of our main findings has been the acceptance, to both patients and staff, that palliative care is integrated into oncology clinics. This is now considered “normal”, and an essential part of the service offered to patients.

As our service has developed, it is apparent that patients’ quality of life improves through our early involvement. The patients we see generally have a good performance status and we aim to support them to continue with anti-cancer treatment or participate in clinical trials.

We have also found that any fears patients once had about palliative care are quickly dispelled when they better understood how we can support them. The old ‘myths’ about palliative care being just about end-of-life care have been replaced, and our team is now seen as being an important part of patients’ journey, right from diagnosis. Patients often tell us they feel ‘more secure’ because they have an additional specialist to ring if they have questions.

As health care providers, it is vital that we offer our patients autonomy and independence over their care. Through our integrated service, we have seen more outpatients manage their pain medications with more ease due to on-going education and support from our team. In some cases, this has prevented patients phoning 999, and avoiding hospital admissions as well as unnecessary visits to A&E.

As a team it has been a fantastic learning experience, and our oncology knowledge has significantly improved, which is important when delivering safe and effective care. In addition, the oncology team feel they have upskilled their knowledge and gained confidence when making decisions about basic pain and symptom control.

Overall, the integration of oncology and palliative care as part of the Enhanced Supportive Care service has served our patients positively, by improving their experience. We hope to be able to secure ongoing funding to continue and expand our work, and we look forward to caring for many more wonderful patients and families who are central to what we do.