A new so-called Triggers tool has been developed by the London Cancer Alliance to help clinicians in the UK recognise patients who need an early referral to specialist palliative care. It has been successfully piloted at the Royal Marsden NHS Foundation, one of ESMO’s Designated Centres of Integrated Oncology and Palliative Care, this year.

The preliminary results of the service proves the usability of this tool by primary care teams and points to the feasibility of establishing the integrated service between oncology and palliative care teams on a wider scale.

Palliative care has traditionally been associated with optimising the quality of life (QoL) at the very end of life. However, research has shown that giving patients early access to specialist palliative care can have many benefits, including improving their prognosis.

The Triggers tool allows oncologists to assess their patients’ needs in this respect at a much earlier stage, and to potentially refer them to specialist palliative care alongside active treatment. In its pilot phase the tool was introduced for new patients at the Royal Marsden’s lung oncology outpatient clinic: in the first four months of the service, 84 per cent of eligible patients were reviewed within two months of their first clinic attendance.

‘We found that 75 per cent of the patients reviewed triggered positive on one or more of the tool items. Of the ‘Trigger positive’ cohort, whose needs were then assessed by a palliative care team, 97 per cent were identified as having at least a moderate need for specialist palliative care – even though 81 per cent of them were still functioning well, ranking in the top two scores on the scale used to assess how a disease affects a patient’s daily living abilities,’ explained Dr Jayne Wood from the Royal Marsden NHS Foundation Trust, who led the evaluation.

‘This tells us that we are addressing a real need, and that the tool is picking up a group of patients who have a real potential to benefit from referral to specialist palliative care. The goal is for the tool to become standard and easy for anyone on a patient’s primary care team to use – for us, the next step will be to expand into other tumour groups,’ said Wood.

A lung cancer woman who was referred to the Royal Marsden after being diagnosed in April 2017, benefited from an early needs assessment via the Triggers tool.

‘I was referred to the palliative care team around a fortnight after arriving at The Royal Marsden. They have helped me with medication, which has given me more energy, visited me at home, and have been able to advise me about different symptoms. I definitely feel that I can call them if I need them,’ she said.

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