In head and neck cancer (HNC) the tumour directly affects an individual’s ability to communicate, swallow, eat and drink, and is often visible, causing significant psychological and social distress. Treatment can exacerbate these problems, with weight loss and malnutrition common. 

The stagnant five-year survival rate for HNC makes quality of life (QoL) increasingly important. Qualitative interviews demonstrate a need for support and care as treatment progresses, arguably greatest at treatment end. 

The Macmillan Aftercare and Rehabilitation Service (MARS) was developed in response to a lack of localised specialist aftercare services for HNC patients, particularly dietitians and speech and language therapists (SLT), as recommended by NICE (2004). 

The team aimed to provide HNC patients, their relatives and/or carers with accessible, specialist Allied Health Professional (AHP) services and resources through choice of location and reduced travel/hospital transportation costs. This included providing a specialist resource to support local hospital clinicians, advancing dietary progression to reduce reliance on nutritional supplements and enteral feeds, and facilitating maximum verbal/non-verbal communication ability. 

A steering group was set up, comprising service users, specialist clinicians from the Cancer Centre and AHPs from the local hospitals. The MARS Team launched outreach clinics at four localities to improve patient accessibility to the team. Clinics were organised to run alongside established HNC consultant clinics.  Remote encrypted computer access to the Cancer Centre was established. 

Total patient contacts for the first year of MARS stood at 1,483. This broke down into 1,116 face-to-face outpatient contacts, 15 inpatient contacts requested by clinicians, and 367 contacts comprising  MDT liaison on specialist patient care issues. 

Improved accessibility to AHPs revealed the need for post-treatment support, and indicated MARS use as a specialist resource. 

Results also showed 63 patients progressing safely from non-oral nutrition/highly modified diet onto normal diet/optimum consistency, with 10 receiving ongoing swallow therapy, , and all patients with impaired communication ability received individualised therapy. 

Most challenges involved the practicalities of working at other sites. Establishing remote encrypted computer access across sites was essential in enabling up-to-date reciprocal exchange of information. 

The team recognised the need for evolving roles to maximise efficiency and adjust service to best patient need.  Initially based in outreach locations, the nutrition nurses were found to have a more useful role within the Cancer Centre. As it became apparent that patients prefer direct clinician contact rather than intermediary, the co-ordinator role became a more hands-on approach. 

The Cancer Centre’s work led to earlier hospital discharge, with patients receiving local AHP reviews. Follow-up appointments were reduced by 50 per cent and attendance at ENT and A&E fell. 

The impact was seen in the reduced cost of feeds, supplements, equipment, home visits and patient appointments. The local hospital benefitted from the availability of a specialist resource, and saw fewer patient transfers between hospitals. 

Patients had better access to AHP. Their problems were identified earlier and clinic appointments, travel and costs were reduced. They had a better overall patient experience.