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NICE Guidance – Service delivery for patients with Sarcomas

NICE Guidance – Service delivery for patients with Sarcomas. What are the key points?. National Institute of Clinical Excellence. What is NICE? How will the guidance work.

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NICE Guidance – Service delivery for patients with Sarcomas

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  1. NICE Guidance – Service delivery for patients with Sarcomas What are the key points? National Institute of Clinical Excellence

  2. What is NICE?How will the guidance work • NICE is a government body that determines the scientific and economic case for adopting a new therapy (it’s called rationing) • It is also involved in preparation and dissemination of guidelines • Service delivery is peer-reviewed so standards will generally be adhered to

  3. Background – current sarcoma care in UK • Late diagnosis (average size =10cm) • Uncertainty where to send patients • Lot of centres treating few patients • Variable adherence to protocols • Variable treatment quality

  4. Patients want to be more involved… • Identifiable keyworker • More information • Pre- referral (who they will see, tests, times etc) • At referral – written information to take away • Post referral – to be able to mull over things

  5. Diagnostic pathway • Streamlined • Diagnostic centres – managed by networks in conjunction with comprehensive treatment centres - lot of options available • All biopsies seen by experienced pathologist • Early radiology review for ‘suspicious’ bones

  6. Pathology • Ideally no pathologist in isolation • Quality approved (system already in place) • Formal links with others • Training needs • National tissue resource

  7. Multidisciplinary Team (MDT) • All sarcoma patients must be managed by a MDT • Minimum workload 100 new STS / yr, 50 new primary bone (or 100 bone) • Why ? Critical mass needed for experience

  8. Core members • 2 of everything (Surg/path/radiol/oncol) • Keyworker • MDT co-ordinator + secretary

  9. Extended members • Paediatric Oncology • Plastics / Chest / GI / ENT • Physiotherapy • Palliative care

  10. Process • Meet weekly • Discuss and document all new cases • Diagnostic + treatment facilities • Data / Trials / Audit (national) /Information etc

  11. Who can give CT + RT? • Nominated units • Participate in trials • Age related facilities • Experience with sarcomas

  12. Rehab + Follow up • Involve patients • Keyworker responsible for liasing

  13. Audit etc • National audit (? Amp rate, LR rate etc) • Minimum data set mandatory • Research incl tissue storage essential • Training for all needed

  14. Advantages • Clear patient pathway • Treated by experienced MDT • Data collection and audit • Research • Better outcomes?

  15. Summary • Rapid referral to diagnostic centre and on to treatment centre • Treatment centres agree and adhere to protocols, trials etc • Less people treat more patients • ? Improved outcomes !

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