Approximately 250 teenagers and young adults are newly diagnosed with cancer every year at University College Hospital London (UCLH), of which 20% include sarcoma.
To cater for their special needs, a Young Person Ambulatory Care unit has been established for TYA patients at UCLH to deliver their chemotherapy treatment while supporting their care in an outpatient setting.
Independently or accompanied by a guardian, patients stay in charity owned hotel accommodation and can access medical care if needed. In this setting, they can socialise with other patients if they wish to. To enable this care, chemotherapy and hydration are administered by a mobile infusion pump which is placed in a backpack.
The aim of the Ambulatory Cancer Care Unit is to improve the quality of care for TYA patients, focusing on maximising their wellbeing, independence and individual needs, normalising their daily life as much as possible, whilst at the same time, reducing the burden on inpatient resources at the hospital.
Dr Katrina Ingley and Dr Sandra Strauss evaluated the safety and feasibility of this approach; the care of 132 TYA sarcoma patients treated at UCLH between January 2020 and May 2022 was reviewed. All were treated with standard chemotherapy regimens. Included in this cohort were 64 (48%) osteosarcoma patients and 36 (27%) Ewing sarcoma diagnosed with either localised or metastatic disease.
During this period, 90% of patients received at least part of their treatment in Ambulatory Care (AC), with 10% receiving chemotherapy solely on inpatient wards due to factors that hampered their independence, or for medical reasons.
Results demonstrated that with AC, chemotherapy was delivered safely, with no increased toxicity and infrequent, manageable unplanned admissions. Feedback was excellent from both patients and staff, with patients being empowered, whilst providing better use of the services available at hospital. Some of this feedback is below.
As soon as I experienced AC didn’t want to go back to the ward.
I felt part of the world, I didn’t feel like I was ill.
It gave me dignity.
Felt supported in AC, the nurses were there.
Dr Katrina Ingley and Dr Sandra Strauss shared:
Our Ambulatory care service has revolutionised the way we provide care for our TYA sarcoma patients and their carers, and has had a major positive impact on their experience through long and difficult treatments. It also has bed/ cost saving benefits, so may be an attractive model of care for other centres across the UK and internationally. We'd be happy to work with other units to implement in their centres.