Prostate cancer is one of the more complex cancer pathways. An initial assessment is followed by an MRI scan and review; then biopsy sampling, reporting and review; before treatment is instigated as appropriate.
Patients in this country should have cancer diagnosed or ruled out within a maximum of 28 days from GP referral, while cancer treatment should commence within 62 days of referral. Cancer systems are required to meet this standard for at least 75% of patients.
In July 2020, patients requiring robotic-assisted radical prostatectomy (RARP) for prostate cancer at East Sussex Healthcare NHS Trust were waiting an average of 60 days from referral to diagnosis and 80 days to commence treatment.
Recognising that the diagnostic element of the pathway was taking too long, the trust established a uro-oncology cancer pathway navigator role, supported with pilot funding from the Surrey and Sussex Cancer Alliance. The vision was to identify and implement ways to expedite the process and enable faster diagnosis.
The introduction of the navigator role has transformed the diagnostic pathway for prostate patients. Waiting times for the diagnosis or ruling out of cancer have almost halved, enabling us to meet our referral to treatment waiting time targets.
The navigator contacts most patients on the day their referral is received to arrange a telephone assessment, which is often carried out on the same day. Patients can be booked into a choice of MRI scan slots each Wednesday and Saturday at the end of the call.
Having established initial contact, the navigator is available to the patient by telephone, text and email, until they receive a diagnosis. This personal contact at a worrying time is highly valued and praised by patients. One patient said:
“The initial contact was so important, as I felt so scared and vulnerable. You really did make a difference to me, and I am sure countless others.”
Another patient said:
“To have such prompt reaction has been nothing short of remarkable, bearing in mind the whirlwind the NHS has experienced in the last [few] years. It is very reassuring to have such a positive first point of contact.”
As a result of this innovation, the average time that patients requiring RARP for prostate cancer wait for their diagnosis has almost halved from 60 days to 32. The time to treatment is now 60 days.
With many patients not requiring clinical appointments, consultants and nurses are able to focus their time on those patients who do need to be seen in clinic. This has led to significant savings in clinical time – over 613 hours’ worth of clinic slots so far, equating to financial savings of more than £196,160.
As a result of the success of the innovation, the trust has adopted navigator roles in lung, colorectal, upper and lower gastro-intestinal and gynaecology. The uro-oncology navigator has acted as an advisor to these services as they have set up the roles, providing learning from their own experience.
The Surrey and Sussex Cancer Alliance (SSCA) said:
“The role has proven invaluable in supporting patients with a key point of contact, personalised information and support throughout a complex diagnostic pathway. Learning from this role has supported SSCA to fund more navigators in other cancer pathways and providers, and the East Sussex Healthcare NHS Trust uro-navigator has contributed to workshops to share and learn opportunities. A community of practice for navigators has been established, where new and experienced post holders can collaborate and further develop the role.”