Being able to easily access cancer treatment is something that should be afforded to every cancer patient. But for those who live hours away from a hospital, long travel times and/or poor transport links can cause a huge amount of stress. This means more precious time spent away from home and not being able to do things that patients love, or the increased financial anxiety that comes with not being able to work.
And if the barriers are too great, in some instances, patients across the country are making the decision not to have treatment at all.
But, there is a solution; mobile cancer care units that provide personalised cancer care so patients can have treatment in more convenient locations at the right time and place for them. This is exactly what’s been happening in Lincolnshire since 2014 where a unit called ‘Elaine’ is an integral part of United Lincolnshire Hospitals NHS Trust’s (ULHT) cancer care service offering.
Providing patient-centric care
For those that work on board Elaine, the experience is overwhelmingly positive. It’s an intimate environment, away from the hustle and bustle of hospital, so nurses can focus solely on treating their patients.
Appointments run to time and patients experience more personal, one-to-one care. This helps to strengthen the patient/staff relationship, with nurses reporting that there’s more chance a patient might mention a concern when receiving their treatment.
While it might not be a hospital in name, the equipment on board is state-of-the art, staffed by Systematic Anti-Cancer Therapy (SACT) trained nurses in a clean and comfortable setting.
The positivity that having the unit creates is something that reverberates throughout the NHS Trust. Hearing the favourable feedback from patients and staff alike helps to reaffirm the essential role it plays.
The unit is an integral part of our service offering and fully embedded. For some patients who might have already been through two lots of surgery before starting their treatment, if they can receive this on the unit in an environment that is more comfortable and means they don’t have to travel as far, that’s going to make a big difference.
– Sarah Chester-Buckley, Deputy General Manager at ULHT
On board Elaine is an environment where patients feel comfortable, relaxed and safe. Shorter and briefer trips give patients more independence so they’re less likely to need to rely on loved ones for transport. Often on the same treatment cycles, it means strong bonds are formed between patients. Helping to create a sense of community while going through cancer treatment provides a valuable source of help and support for patients.
For some who visit Elaine, they may only be on board for 15 minutes. This includes patients who take chemotherapy in tablet form or those who might need a line flushing. For patients with terminal cancer, they may expect to have to travel for treatment every three weeks over several years. Both are compelling reasons why the mobile cancer care unit is such an important addition to ULHT.
Lynn Cockerill, has worked as deputy sister on the unit for seven years, and has seen first-hand the difference the unit makes:
“A lot of patients have been coming to the unit for years so you build a relationship with them. They trust me and know I will go the extra mile. I find that this makes them more likely to talk to you about things they’re worried about. For example, I had a patient receiving oral chemotherapy who over the phone had said they were okay, but when they came to the unit for treatment, felt more comfortable to say that they weren’t and they were admitted to hospital.
“But conversation isn’t always confined to treatment. I had a patient whose wife had lung cancer and as she became more poorly, I was able to provide advice about getting them some help at home. This was something that made a big difference to them and in a busy hospital environment, I think this type of conversation would be less likely.
“I know that the patients themselves are also a great support to each other, messaging outside of their treatment and have even set up support groups.
“When the unit was first launched, we worked really hard to make sure that it was used as effectively as possible. It was important that we got the process right, especially with the schedulers and the pharmacy so that treatments could be grouped together and the right drugs delivered.
“It really was, and still is, a team effort. And because mobile cancer care wasn’t something people in Lincolnshire were aware of, we worked hard to get patients to use the unit for treatment. We’d look at patient lists and be in regular contact with the schedulers to make sure we could fill all our allocated slots. We also made sure that staff in the hospital knew about the service so that they could speak to eligible patients to see if they wanted to be treated on the unit.
“Seeing the difference the unit makes so that patients can have their treatment in a more convenient location and in such a calm and friendly environment gives me a huge amount of pleasure. I refer to everyone on Elaine as my family as that’s exactly what it feels like.”
Charlotte’s experience
For secondary breast cancer patient, Charlotte Graves, receiving her treatment on board the unit has given her back valuable time as it’s just ten minutes from where she lives.
“In December 2018, I was told I had breast cancer. It was quite aggressive, and I was also 26 weeks pregnant. It was a very, very frightening time,” she recalls.
After undergoing a full mastectomy, Charlotte gave birth to her son Charlie six weeks early by C-section, before embarking on cancer treatment less than a week later while still in Lincoln Hospital.
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Following radiotherapy, she continued her treatment plan at home via community nursing where she was put on a course of Herceptin. She underwent 18 sessions over the next 12 months. After being given the all clear, just four months later she discovered she had secondary breast cancer.
“As this was during COVID, there was a lot of travelling to both Lincoln and Grantham hospitals for more treatment. I was then referred to the mobile care unit, which is based in Louth, just seven miles away from where I live.”
Every three weeks, Charlotte visits the unit to have Kadcyla, her chemotherapy infusion, which she refers to as her ‘maintenance treatment’ as there is no cure for her.
“If I was having the treatment at Lincoln Hospital, it’s an hour’s drive away. There are a lot of people much worse off than me and I’m just so grateful for the treatment so I’m not complaining, but the whole trip would take the best part of a day.
“It’s great as now it’s just on the mobile unit which is just 10 minutes away – I’m usually in and out within the hour.”
She reflects on the difference the unit has made to her life: “I used to drop my son off to nursery enroute to the hospital, and my husband Paul would have to take time out of work to drive me and wait around. Now I’m able to get myself to the unit and back as it’s closer.”
This has saved Charlotte precious time that she puts to good use: “Just before my next round of treatment is when I have the most energy as it’s the end of the cycle. In the morning prior to my appointment, I drop my son off and then come home and use that extra time to get everything done that needs to be done. I can cook a nice family dinner whereas before it was just a freezer meal! When I return from treatment, I know I have the rest of the day and the day after to just relax as the chemo wipes me out. Before now, I’ve tried to carry on and ended up putting myself in hospital because I’ve overdone it. It just gives me crucial recovery time.”
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Following radiotherapy, she continued her treatment plan at home via community nursing where she was put on a course of Herceptin. She underwent 18 sessions over the next 12 months. After being given the all clear, just four months later she discovered she had secondary breast cancer.
“As this was during COVID, there was a lot of travelling to both Lincoln and Grantham hospitals for more treatment. I was then referred to the mobile care unit, which is based in Louth, just seven miles away from where I live.”
Every three weeks, Charlotte visits the unit to have Kadcyla, her chemotherapy infusion, which she refers to as her ‘maintenance treatment’ as there is no cure for her.
“If I was having the treatment at Lincoln Hospital, it’s an hour’s drive away. There are a lot of people much worse off than me and I’m just so grateful for the treatment so I’m not complaining, but the whole trip would take the best part of a day.
“It’s great as now it’s just on the mobile unit which is just 10 minutes away – I’m usually in and out within the hour.”
She reflects on the difference the unit has made to her life: “I used to drop my son off to nursery enroute to the hospital, and my husband Paul would have to take time out of work to drive me and wait around. Now I’m able to get myself to the unit and back as it’s closer.”
This has saved Charlotte precious time that she puts to good use: “Just before my next round of treatment is when I have the most energy as it’s the end of the cycle. In the morning prior to my appointment, I drop my son off and then come home and use that extra time to get everything done that needs to be done. I can cook a nice family dinner whereas before it was just a freezer meal! When I return from treatment, I know I have the rest of the day and the day after to just relax as the chemo wipes me out. Before now, I’ve tried to carry on and ended up putting myself in hospital because I’ve overdone it. It just gives me crucial recovery time.”
Whether it’s the additional travel time and associated stress or the financial impact on low income households of having to miss work or using unreliable public transport, if cancer patients are taking the decision to forgo treatment, it’s essential that this is addressed. The units also deliver much needed additional capacity across Lincolnshire as the population continues to grow.
The need
Lincolnshire is a large rural county with a scattered population. More than 50% live in areas with fewer than 15,000 residents. In Mablethorpe and Skegness particularly there is an aging, retired population, many of whom don’t have family close by who can take them to appointments. And coupled with the high-rate of complex health needs, if someone is unable to drive due to complications with, for example, Diabetes, that adds further difficulty.
Transport infrastructure is limited, with mostly minor roads and just 30 miles of dual carriageway. In the east of the county, there are significant health inequalities and high-instances of co-morbidities. While outpatient care treatment is offered at Boston, Lincoln and Grantham, this still leaves geographical ‘gaps’ in the provision of cancer treatment care.
This can present huge challenges with accessing treatment. It’s not just the distance that patients might have to travel, but those living in more deprived areas are likely to come from lower socio-economic backgrounds. This means it’s more likely they would rely on public transport and it could be more difficult to take time off work to receive treatment.
The need
Lincolnshire is a large rural county with a scattered population. More than 50% live in areas with fewer than 15,000 residents. In Mablethorpe and Skegness particularly there is an aging, retired population, many of whom don’t have family close by who can take them to appointments. And coupled with the high-rate of complex health needs, if someone is unable to drive due to complications with, for example, Diabetes, that adds further difficulty.
Transport infrastructure is limited, with mostly minor roads and just 30 miles of dual carriageway. In the east of the county, there are significant health inequalities and high-instances of co-morbidities. While outpatient care treatment is offered at Boston, Lincoln and Grantham, this still leaves geographical ‘gaps’ in the provision of cancer treatment care.
This can present huge challenges with accessing treatment. It’s not just the distance that patients might have to travel, but those living in more deprived areas are likely to come from lower socio-economic backgrounds. This means it’s more likely they would rely on public transport and it could be more difficult to take time off work to receive treatment.
Whether it’s the additional travel time and associated stress or the financial impact on low income households of having to miss work or using unreliable public transport, if cancer patients are taking the decision to forgo treatment, it’s essential that this is addressed. The units also deliver much needed additional capacity across Lincolnshire as the population continues to grow.
The solution
In 2013, ULHT offered cancer services at two hospital sites which were bursting at the seams. Looking at how they could increase treatment capacity, the Trust went through an options appraisal to determine the best solution. After researching mobile cancer care, it was added to the appraisal list.
As part of the scoring system, the biggest weighting was given to patient safety, and also included patient experience and cost. Mobile cancer care treatment came out top and the unit was given the green light; it offered an extremely flexible option that could be re-deployed as needed. Something a static site simply couldn’t do.
Originally the Hope for Tomorrow mobile cancer care unit went out four days a week, but this has now increased to five due to demand. There are four treatment chairs on board, staffed by two SACT trained nurses who treat between 18 and 20 patients a day. Patients who would otherwise be seen in hospital.
While not all treatments are suitable to be delivered on the mobile unit, and a first treatment will always be administered in hospital, the schedulers are able to maximise the number of patients that can be seen every day. This makes it an extremely efficient way of delivering cancer treatment.
Patients on board receive shorter treatments which helps to free up capacity in hospital for those who have more complex treatment needs.
Thanks to the support from Elaine, 13% of the oncology treatments that would otherwise be carried out in hospital are delivered on board.
Ensuring that as many people as possible, in the areas of the greatest need, can receive treatment on the unit, the team uses postcodes from a patient list to create a heat map. Using this data, decisions can be made as to where the unit will have the biggest impact.
The solution
In 2013, ULHT offered cancer services at two hospital sites which were bursting at the seams. Looking at how they could increase treatment capacity, the Trust went through an options appraisal to determine the best solution. After researching mobile cancer care, it was added to the appraisal list.
As part of the scoring system, the biggest weighting was given to patient safety, and also included patient experience and cost. Mobile cancer care treatment came out top and the unit was given the green light; it offered an extremely flexible option that could be re-deployed as needed. Something a static site simply couldn’t do.
Originally the Hope for Tomorrow mobile cancer care unit went out four days a week, but this has now increased to five due to demand. There are four treatment chairs on board, staffed by two SACT trained nurses who treat between 18 and 20 patients a day. Patients who would otherwise be seen in hospital.
While not all treatments are suitable to be delivered on the mobile unit, and a first treatment will always be administered in hospital, the schedulers are able to maximise the number of patients that can be seen every day. This makes it an extremely efficient way of delivering cancer treatment.
Patients on board receive shorter treatments which helps to free up capacity in hospital for those who have more complex treatment needs.
Thanks to the support from Elaine, 13% of the oncology treatments that would otherwise be carried out in hospital are delivered on board.
Ensuring that as many people as possible, in the areas of the greatest need, can receive treatment on the unit, the team uses postcodes from a patient list to create a heat map. Using this data, decisions can be made as to where the unit will have the biggest impact.
The impacts
The Hope for Tomorrow mobile unit has helped to improve access to cancer treatment and address some of the health inequalities that people in Lincolnshire experience. More cancer patients are receiving treatment in their communities, reaching those who need it most, while helping to increase capacity in stretched hospitals.
The benefits of the unit are significant and wide reaching; for patients, their friends and family, NHS staff and the Trust.
The team on board Elaine has administered more than 18,000 treatments since its launch and it is now an integral part of the cancer care service provided by ULHT. The unit aligns with all the strategic objectives outlined in the Trust’s Integrated Improvement Plan (IIP) for 2020-2025, helping to embed the key aim of ‘Outstanding Care, Personally Delivered’. Alongside the IIP, the mobile unit supports the Living With and Beyond Cancer Programme and the NHS’s longer term plan of bringing cancer treatment closer to patients.
Use of the unit has increased over time and it currently sees, on average, 350 patients per quarter. This means it plays a crucial role in helping ULHT to achieve the NHS’s 31 days subsequent drug cancer standard of 98%.
“Our relationship with Hope for Tomorrow plays a pivotal role in the strategic approach to the delivery of chemotherapy to our patients of Lincolnshire. Having the mobile cancer care unit ensures that we can deliver Chemotherapy closer to home which is essential in such a rural county. The unit allows us to release capacity in our chemotherapy suites at both Boston and Lincoln which in turn reduces wait times for the commencement of treatment. We receive positive feedback from our patients and staff who consider the mobile unit essential for the quality of patient care.”
– Diane Lynch, Divisional Clinical Managing Director, Clinical Support Services, United Lincolnshire Hospitals NHS Trust
The impacts
The Hope for Tomorrow mobile unit has helped to improve access to cancer treatment and address some of the health inequalities that people in Lincolnshire experience. More cancer patients are receiving treatment in their communities, reaching those who need it most, while helping to increase capacity in stretched hospitals.
The benefits of the unit are significant and wide reaching; for patients, their friends and family, NHS staff and the Trust.
The team on board Elaine has administered more than 18,000 treatments since its launch and it is now an integral part of the cancer care service provided by ULHT. The unit aligns with all the strategic objectives outlined in the Trust’s Integrated Improvement Plan (IIP) for 2020-2025, helping to embed the key aim of ‘Outstanding Care, Personally Delivered’. Alongside the IIP, the mobile unit supports the Living With and Beyond Cancer Programme and the NHS’s longer term plan of bringing cancer treatment closer to patients.
Use of the unit has increased over time and it currently sees, on average, 350 patients per quarter. This means it plays a crucial role in helping ULHT to achieve the NHS’s 31 days subsequent drug cancer standard of 98%.
“Our relationship with Hope for Tomorrow plays a pivotal role in the strategic approach to the delivery of chemotherapy to our patients of Lincolnshire. Having the mobile cancer care unit ensures that we can deliver Chemotherapy closer to home which is essential in such a rural county. The unit allows us to release capacity in our chemotherapy suites at both Boston and Lincoln which in turn reduces wait times for the commencement of treatment. We receive positive feedback from our patients and staff who consider the mobile unit essential for the quality of patient care.”
– Diane Lynch, Divisional Clinical Managing Director, Clinical Support Services, United Lincolnshire Hospitals NHS Trust
