NCEPOD-2008

Methods A 2008 report by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), examined the process of care of patients who died within 30 days of receiving systemic anti-cancer therapy (SACT) in June or July 2006.
Participants and Country Patients who died within 30 days of receiving systemic anti-cancer therapy (SACT) in June or July 2006. Patients were identified via questionnaires sent to individual National Health Service hospitals in England, Wales and Northern Ireland, as well as hospitals in the independent sector and public hospitals in the Isle of Man, Guernsey and Jersey.
Interventions Systemic anti cancer therapy.
Outcomes Quality of Care
The NCEPOD advisors judged that 35% of patients who died within 30 days of SACT received good care. In 49% of the patients patients the advisors identified room for improvement in care.
Discussion of treatment plan by MDT
The clinical management plan was discussed at an MDT meeting in only 58% (335/578) of patients who died within 30 days of SACT.
The cohort included 23 patients with CUP (4.8% of the total number). 10 of these patients had their treatment plan agreed by an MDT, 10 did not and there was no information about the remaining 3 patients.
Recommendations of the report's advisors
All hospitals with A&E departments should establish an acute oncology service with access to specialist oncological advice.
Decisions to initiate chemotherapy should be taken at the consultant level. Constultants should use standardised consent forms including details of both common and serious toxicities, which have been discussed with the patient
Recommendations were also made about the prescribing, dispensing and delivery of chemotherapy, patient information, recording of toxicity, end of treatment record, models of service delivery, leadership, clinical governance, peer review, data collection and training.
Notes

From: Guideline chapter 1, Service Configuration

Cover of Diagnosis and Management of Metastatic Malignant Disease of Unknown Primary Origin
Diagnosis and Management of Metastatic Malignant Disease of Unknown Primary Origin.
NICE Clinical Guidelines, No. 104.
Copyright © 2010, National Collaborating Centre for Cancer.

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