NCAG Report Published
The final version of the National Chemotherapy Advisory Group (NCAG), "Chemotherapy Services in England: Ensuring quality and safety" has been published . The group is co-chaired by ex-ACP Chair Peter Clark. The recommendations of the report will be a challenge for oncology services around the country. The NCEPOD report (no longer available) on deaths of patients within 30 days of chemotherapy was published in 2008. See the presentations from the Acute Oncology Annual Meeting for more information.
The report highlights 3 main areas:
- Provision of chemotherapy services based on a care pathway approach
- Provision of emergency care for cancer patients through an “acute oncology service (AOS)”
- The organisational support around chemotherapy services
The key recommendations have been summarised here:
- Acute oncology service (AOS): All hospitals with A&E should establish an AOS to improve the management of cancer patients admitted as an emergency.
- Decisions on the initiation of treatment should be made at consultant level; patients should be fully informed and consented.
- Cancer Networks should have a regularly updated, easily accessible “Protocol Book” and pre-printed forms or electronic prescribing used. Staff involved in the prescribing, verification, and dispensing should be appropriately trained.
- Inpatient delivery of chemotherapy should be minimised, local services developed where appropriate, and patients views sought.
- Patients should receive verbal and written information about treatment, toxicities, and who to contact with problems. 24-hr telephone advice should be available.
- Patients should know which hospital to go to if they have complications. There should be policies for management of complications and 24-hr access to advice from a consultant oncologist. Hospitals without an AOS should have treat and transfer arrangements. The Acute Oncology Team (AOT) should be informed within 24-hrs of any patient on chemotherapy attending A&E.
- Each Trust must have policy for management of febrile neutropnia. NICE is developing a National Clinical Guideline.
- Toxicities of chemotherapy must be recorded and this information must be available to staff subsequently prescribing or administering treatment.
- An end of treatment record should be completed after each course of treatment, and a subsequent care plan agreed.
- The deaths of all patients within 30 days of chemotherapy caused or hastened by treatment should be reported to HM Coroner.
- Leadership should be provided by Chemotherapy and Acute Oncology Teams (AOTs)
- The protocols and policies in this report need to be developed, implemented and regularly audited. There should be regular morbidity/mortality meetings to review practice.
- New peer review measures will be developed.
- Expansion in the workforce will be required including medical, pharmacy and nursing.
- Competencies will be updated and training programmes developed.
- A new mandatory dataset will be developed by the National Cancer Intelligence Network (NCIN).
- Commissioning will have to reflect the recommendations of the report.