title: The holistic management of consequences of cancer treatment by a gastrointestinal and nutrition team: a financially viable approach to an enormous problem?
abstract: 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.
authors.affiliation: GI Unit, The Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: Ann C
authors.initials: AC
authors.lastname: Muls
authors.affiliation: GI Unit, The Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: Amyn
authors.initials: A
authors.lastname: Lalji
authors.affiliation: GI Unit, The Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Marshall
authors.affiliation: Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: Lewis
authors.initials: L
authors.lastname: Butler
authors.affiliation: Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Shaw
authors.affiliation: GI Unit, Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Vyoral
authors.affiliation: GI Unit, Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: Kabir
authors.initials: K
authors.lastname: Mohammed
authors.affiliation: GI Unit, Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: H Jervoise N
authors.initials: HJ
authors.lastname: Andreyev
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D000072102:Gastroenterologists; D006694:Holistic Health; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000523:psychology / Q000628:therapy*; D064686:Nutritionists; D011446:Prospective Studies; D055815:Young Adult
keywords: Cancer; cancer treatment; chemotherapy; consequences; cost; gastrointestinal; hormone treatment; radiotherapy; surgery; survivorship; symptoms