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An innovative approach to supporting patients in Fife with incurable lung cancer is providing comprehensive and individualised care whilst allowing patients to spend significantly less time in hospital and more time at home.

The pilot project, funded through the TransformingCare After Treatment (TCAT) programme, was developed in partnership with NHS Fife, Fife Health and Social Care Partnership and Macmillan Cancer Support Scotland - and has proved so successful that this new model of care for people with advanced lung cancer has been embedded into normal practice.

In Fife, around 40% of patients diagnosed with lung cancer are unfit to receive anti-cancer treatments such as surgery, radiotherapy or chemotherapy, either because they are too unwell or treatment is no longer working and may reduce their quality of life.

These patients receive what is known as Best Supportive Care – where the focus is on supporting patients and their families when anti-cancer treatment is not possible.  

Previously, it wasn’t always clear what Best Supportive Care meant in practice. The project focussed on developing a reliable and consistent model of Best Supportive Care, ensuring that it could be delivered to all patients who needed it.  

As a result, patients with advanced lung cancer are identified at the earliest stage and referred for comprehensive assessment and personalised care planning. These assessments are carried out promptly at home, in an outpatient clinic or within hospital, depending on patient need and preference, with families and carers given the opportunity to discuss the illness in more detail.

Physical symptoms, emotional, spiritual and practical needs are assessed and plans are made to address anything of concern, from medication changes to issues around financial support. Conversations also begin about a patient’s preferences as they become less well, including options for additional support. Follow-up is based wherever the patients are, most commonly in their own homes, but also in hospital if necessary.

This new approach has ensured that all patients who need Best Supportive Care are assessed and supported in a location that suits them. Clinic appointments in hospital are often no longer needed, with people usually choosing to be supported in their own homes.

The service has been positively received by patients, families and carers, who have said they feel well informed, actively involved in their care planning, and able to maintain independence by knowing where to access support when needed.  

Dr Frances Elliot, NHS Fife Medical Director, said: “The Transforming Care After Treatment Programme has been an important step in defining care pathways for patients with advanced lung cancer, ensuring that teams are able to deliver the very best support to patients at an early stage.

“We want to give as much control and choice to patients as possible, making their journey easier, at what is obviously a difficult time.  By supporting patients at the earliest stage we can answer their questions and explore their wishes as well as providing practical care.

“Crucially, patients are able to access ongoing support and advice and know how to access that support.”

Dr Steinunn Boyce, Consultant in Palliative Care Medicine, said: “We set out on this project to improve patient care and patient experience, not only for the patient but for their families and the important people around them who are also affected by the diagnosis.

“Being in hospital is sometimes unavoidable and it’s sometimes the right place to be, but through this project we have been able to reduce the length of time that people spend in hospital  - making sure that we are addressing their needs and supporting them so they can be at home.”

Gordon McLean, Macmillan’s National Programme Manager, said: “I am delighted that this new model of care for people with advanced lung cancer has been embedded into normal practice.

“I hope other health boards will look at the successes of this project and consider how its lessons can be used to improve care after treatment for people with all types of cancer across Scotland.”