Acute Oncology Service (AOS) in NHS Scotland: principles

2. What is Acute Oncology?

Acute oncology (AO) is a cross cutting service responding to the emergency needs of patients who have been under the care of oncologists or haemato-oncologists. These patients can present to emergency services as a result of treatment side effects, other oncological emergencies or uncontrolled symptoms of disease. In addition to this, many patients who are previously unknown to cancer services present as an emergency with a suspected new cancer diagnosis, and for whom the first diagnosis of cancer is made in the emergency setting – malignancy of unknown primary origin (MUO) or cancer of unknown primary (CUP). This group of patients are often acutely unwell with late presentation of disease.

Although patients are often treated in specialist oncology centres, they are more likely to present to their local hospital when acute problems develop. Specialist acute oncology services ensure that these patients receive the care they need quickly and in the most appropriate setting. Existing services have evidenced:

• Improvement overall on patients’ experience and outcomes;
• Reduction in urgent care demand, emergency attendances, diagnostic tests and interventions of negligible value;
• Reduction in average length of stay in hospital of up to 40%¹
• Reduction in readmission rates;
• Less delay to definitive treatment or progression to palliative and supportive care as appropriate;
• Reduction in avoidable deaths due to complications of treatment; and
• Reduction in overall cost of care by providing earlier interventions and more efficient pathways.

At present there is a deficit in the provision of dedicated AOSs across the country, with inequity of access to these specialist services. Acutely unwell patients can present to many hospitals across Scotland and current services are acknowledged to be varied, lacking structure and coordination. It is not intended that specialist AOSs replace existing and established cancer disease-specific pathways, but are there to enhance immediate care in this patient group.

Early feedback from users of an existing specialist AOS demonstrates the positive impact this can make for patients and services.

It is very helpful for us as we often see patients with cancer of unknown primary. It is helpful to have advice from an oncologist before pursuing investigations that might be fruitless and unpleasant. It helps practice realistic medicine.

I’ve only referred one patient to date but was very happy with the prompt response of the team and the early follow-up which was arranged for the patient. All of this was also much appreciated by the patient who was able to get home earlier and be in her own environment during what was a stressful time for her.

Great service which has provided invaluable advice on investigation and management of patients. The input of the AOS has aided and expedited clinical decision making, leading to improvements in patient care, rationalisation of investigations and certainly has reduced length of stay in some of my patients.

This service is a huge help for patients both presenting with new malignancy and established patients on complicated drug regimens. I very much appreciate their input.

An essential service, long-awaited and massively improves the patient journey.

It was excellent – the medical team were very helpful and active in directing early investigation of this young man with newly diagnosed cancer. It made a real difference to his care. This is a great improvement.

The principal role of the specialist AOS in emergency cancer care is advisory, however the positive impact and benefits of the service will be seen across multiple areas:

Patients / Carers

• Overall improved patient experience and outcomes, and improved families experience by providing advice, prompt communication and support
• Establishing the most clinically appropriate care pathway, providing more timely access to the right treatment, in the right place, at the right time
• Improved communication and signposting to appropriate specialist advice and services
• Increased involvement in complex discussions around end of life care, decision making, and plans and need for hospital admission

Staff

• Front door specialist staff in place
• Access to prompt expert/specialist opinion through referral to, and liaison with, other specialties
• Upskilling of the multidisciplinary team in the acute unit
• Standardised training and education opportunities

Services

• Improved use of existing capacity and resource, particularly alleviating pressure at medical front doors, diagnostics and inpatient bed capacity in General Medicine
• Specialist staff to appropriately manage and direct AO patients
• Supporting early realistic medicine discussions with patients about “what matters to you?”
• Streamlined, effective communication across specialities