Supporting Cancer Services
““The challenges are enormous; there are not enough people and not enough money.
We have a good problem in cancer, which is that we have lots of patients on long-term therapies but the challenge of monitoring these patients safely has been almost insurmountable for our service. We’re leveraging the staffing as much as possible but we need other ways to safely monitor treatment…
My Clinical Outcomes is one of the ways that we’ve chosen to do that.”
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In 2017, a Randomised Controlled Trial was published in the Journal of the American Medical Association that unequivocally demonstrated the benefits of using remote, digital Patient-Reported Outcome Measures (PROMs) to support routine cancer care. In the trial group using PROMs:
Nearly a third (31%) of patients experienced better quality of life and better physical function.
They needed to attend Accident & Emergency 7% less often.
They were able to remain on potentially life-prolonging chemotherapy for an average of 2 months longer.
Survived on average 5 months longer (a 20% increase).
At 5 years, 8% more patients were alive in the self-reporting group.
In summary, the study showed that PROMs can help cancer teams to support patients to live better quality, longer lives, while saving the health system money by allowing teams to intervene sooner to avoid unplanned admissions.
Visit the journal website to read more about this study.
Since this study was published, MCO has worked on a variety of oncology projects, including:
Winning 4 years of ‘Cancer Innovation Challenge’ funding to support cancer patients in Scotland culminating with 23 clinical teams using the platform across 8 health boards during the Covid-29 pandemic.
Working with Macmillan Cancer Support and the Royal College of Radiologists to develop a solution that was implemented at 4 NHS Trusts to screen patient for late complications after pelvic radiotherapy.
Tracking recovery from cancer surgery in colorectal patients at Chelsea and Westminster NHS Foundation Trust.
Working with University Hospitals Sussex supportive oncology service in a project that independent health economic analysis showed would save £1.40 for every £1 invested.
How PROMs Help Improve Cancer Care
Person-Centred Care: During cancer treatment clinicians tend to focus their limited time with patients on screening for toxicity and making sure patients are well enough to continue treatment. PROMs can help highlight specific symptoms or concerns that might have been missed and which may otherwise have gone on to cause patients to need to stop treatment. For example, if a patient reports significant fatigue or emotional distress, interventions can be tailored to help manage these alongside cancer treatment.
Shared Decision-Making: PROMs can help clinicians to understand patients' preferences, concerns, and priorities when making treatment decisions to collaboratively agree treatment options that best align with the patients' goals and values.
Early Detection of Complications: PROMs can help identify potential complications or side effects of treatment early on. For instance, if a patient reports declining physical functioning or increased pain, clinicians can intervene promptly to prevent further deterioration.
Efficient Use of Resources: By allowing clinicians to intervene earlier and more proactively, patients can potentially be discharged from acute services sooner, or prevented from deteriorating to the point that they need to attend A&E or be admitted for acute treatment. For example, a patient with progressive shortness of breath highlighted by remotely captured PROMs might be treated for pneumonia at home before needing to come to hospital. This is better for patients also because it means their cancer treatment will not be interrupted, but also saves the health system money.
Research and Quality Improvement: Aggregated PROMs data can be used for research purposes and quality improvement initiatives. Analysing large datasets of PROMs responses can lead to insights about treatment outcomes, patient experiences, and areas for improvement in cancer care delivery. For example, University Hospitals Sussex has researched the development of a specialist fatigue service because of the burden of fatigues highlighted by PROMs data.
Survivorship and Long-Term Follow-Up: PROMs can assist long-term follow-up care for patients in remission or who are ‘living with and beyond cancer’ by allowing cost-effective tracking of quality of life and any late effects of treatment to guide ongoing care plans and interventions.
Key MCO Oncology Experience
Cancer Innovation Challenge, 2017 – 2020
““Firstly this is convenient. Secondly, this unearths levels of toxicity and side effects that might not have been identified by other methods and it allows more of a direct comparison between patients than was previously available.”
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In 2017, the Scottish Funding Council announced a £1M funding call to help Scotland become a world leading carer for people with cancer through for data science solutions. The first phase sought innovations to “integrate PROMs data into Scotland-wide health care processes to:
Improve experiences of treatment, care, and personal outcomes.
Understand the clinical and psychosocial impact of new and established cancer treatment.
Make better use of NHS resources by reducing waste and inefficient practices.
Accelerate the adoption of new technologies into the NHS through efficient evaluation mechanisms.
Create high value research infrastructure with global reach.
Out of around 130 bids overall, MCO was one of 5 companies to win a first phase of funding, one of 2 companies to win a second phase and the only company to win a third, fourth and fifth phase of funding included developing:
Acute chemotherapy toxicity monitoring at NHS Ayrshire and Arran.
Supporting prehabilitation and rehabilitation as part of a surgical care pathway for ovarian cancer patients at NHS Greater Glasgow and Clyde.
Quality of Life assessment and monitoring of patients with newly diagnosed cancer in six tumour types across four health boards of the South and East Scotland Cancer Network (SCAN).
Enabling stratified follow-up care pathways for secondary breast cancer patients at The Beatson.
Integrating with the National Digital Platform and local electronic medical records.
In addition, during the Challenge MCO was:
Winner: Industry Collaboration Award at the Digital Healthcare Awards 2020, for ‘Using Digital Patient-reported Outcomes To Enhance Routine Cancer Care’ with NHS Ayrshire & Arran.
Featured in an article 'Pilot success for award-winning My Clinical Outcomes cancer tool', published by The National newspaper.
Celebrated at ‘The Data Lab: Supporting Transformative Projects’ reception in the Scottish Parliament building, where keynote speaker Dr Peter MacLean discussed the real difference MCO has made to the efficiency of his clinics and the impact it has had on his patients.
Featured in The Data Lab ‘Cancer Innovation Challenge’ podcast series. Recorded prior to the COVID-19 pandemic, it summarises MCO’s involvement in the Cancer Innovation Challenge (from 8 mins) and highlights the application of MCO specifically in supporting remote consultations (from 11 mins).
Read more about the use of MCO in the Cancer Innovation Challenge on our Case Study page.
University Hospitals Sussex and NHS Sussex Integrated Care Board (ICB), 2020 - Present
““This works for all cancer patients regardless of stage or diagnosis…. Clearly an excellent system that’s user-friendly.”
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MCO was initially introduced to University Hospitals Sussex NHS Foundation Trust in late 2020 as part of an NHS England funded Supporting Oncology project that aimed to give the palliative care team advanced visibility of quality of life data from patients referred by oncology colleagues to help them prioritise patients for review and respond more proactively to patients’ needs.
During the one year pilot, MCO was widely adopted, and was found to be straightforward to implement despite capacity constraints caused by the Covid-19 pandemic, easy for patients to use, and clinically beneficial. A second year was supported and funded by Sussex Cancer Fund before the system was adopted for wider roll-out by NHS Sussex Integrated Care Board (ICB) in May 2023.
Independent health economic analysis of the results of the project was conducted by Unity Insights, a specialist analytics and evaluation consultancy, with the results published in the British Medical Journal (BMJ) of Supportive & Palliative Care in 2022. Some of the key findings included:
5% fewer unplanned admissions.
Length of admissions shorter by an average of 1.43 days.
Reduced risk of emergency admission to hospitals.
In addition, results showed a return on investment with a benefit cost ratio of 1.4 – that is, for every £1 invested in the service, £1.40 was saved.
More information about the Unity Insights research is can be found on their website and more information about the use of MCO at University Hospitals Sussex can be found on our Case Study page.
““When patients come to clinic to see me I can see what’s happening with them, [My Clinical Outcomes] makes clinics efficient and we can triage problems effectively together in a good quality conversation.”
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Watch Prof. Simcock discuss how and why he uses My Clinical Outcomes with his patients this short video below.
Watch Prof. Simcock’s Keynote at ‘Intelligent Health UK’ conference in London in May 2023, ‘When Personalised Care Meets Technology: Taking a Person-centred Approach to Cancer Care Innovation’, with My Clinical Outcomes discussed from 9min 50sec.