RT Journal Article
SR Electronic
T1 The holistic management of consequences of cancer treatment by a gastrointestinal and nutrition team: a financially viable approach to an enormous problem?
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 240
OP 246
DO 10.7861/clinmedicine.16-3-240
VO 16
IS 3
A1 Ann C Muls
A1 Amyn Lalji
A1 Christopher Marshall
A1 Lewis Butler
A1 Clare Shaw
A1 Susan Vyoral
A1 Kabir Mohammed
A1 H Jervoise N Andreyev
YR 2016
UL http://www.rcpjournals.org/content/16/3/240.abstract
AB There is no national NHS tariff to fund services for patients experiencing long-term bowel and nutritional problems after cancer treatment. In this paper, we report the clinical characteristics and outcomes of patients referred to our service and the estimated cost of a completed episode of care. Patient characteristics, symptom severity, investigations, diagnoses, number of clinic visits and referrals elsewhere were recorded in a prospective cohort study. During 2013–14, 325 patients completed assessment and treatment. The majority of original cancer diagnoses were urological (43%) and gynaecological (21%). A median of six investigations were requested. 62% were found to have three or more new diagnoses including small intestinal bacterial overgrowth (46%), vitamin D deficiency (38%), bile acid malabsorption (28%), gastritis (22%), radiation-induced bleeding (20%), vitamin B12 deficiency (17%), pelvic floor weakness (17%), colorectal polyps (13%) and pancreatic insufficiency (5%). A median of three visits were required and all commonly reported gastrointestinal symptoms improved by discharge. The mean episode of care per patient was costed at £1,563. Effective amelioration of chronic gastrointestinal toxicity after cancer treatment costs substantially less than treating the cancer in the first place and requires an NHS tariff.