Non surgical oncology – or NSO for short - is the name given to services that provide treatment and care for cancer patients without surgery – mainly chemotherapy and radiotherapy.
NSO services in our region are organised in a unique way that was agreed more than 20 years ago.
The delivery of NSO services has become increasingly challenging over recent years. With more people living with cancer and receiving treatment for longer, demand has grown at a faster rate than the numbers of health professionals working in this particular specialism of cancer care.
The Cancer Alliance has been asked by West Yorkshire Association of Acute Trusts to review the way in which the chemotherapy and acute oncology aspects of the non surgical oncology services are delivered across West Yorkshire and Harrogate, with recommendations for improvement.
There is a separate piece of work just starting with colleagues in Leeds to look at future radiotherapy service expansion. We will work to bring these two pieces of work together where appropriate.
Here is where you can learn more about non surgical oncology, the improvements being proposed and why the changes are needed. Read more below.
There is also an opportunity to have your say about the proposals.
Get involved and give your views - learn more about our NSO community engagement.
Non surgical oncology – or NSO for short - is the general name given to all services that provide treatment and care for cancer patients without surgery – mainly chemotherapy and radiotherapy.
Specialist cancer doctors are called oncologists. There are two different specialisms within oncology both focusing on the diagnosis and treatment of cancer.
Medical oncologists specialise in the use of drugs - including chemotherapy - to treat cancer.
Clinical oncologists are specialists in the use of radiotherapy for cancer treatment but can also prescribe and oversee cancer drug treatments.
Both medical and clinical oncologists monitor the progress of patients, keep track of their symptoms and provide supportive care, including care for those patients who are acutely unwell and need admission to hospital.
The current NSO programme focuses on the chemotherapy and acute oncology aspects of the non surgical oncology services across West Yorkshire.
Why are we looking to make changes to non surgical oncology services?
West Yorkshire is different to the rest of the country in the way its NSO services are delivered. Here, each Cancer Unit employs its own specialist teams to deliver local non-surgical oncology drug treatments for the common cancers (breast, bowel, prostate and lung), with specialist care provided at the Cancer Centre in Leeds. Elsewhere in England, local services are usually provided as a visiting service from the Cancer Centre.
Over recent times, it has proved difficult to recruit the required number of specialist doctors (oncologists) particularly in some parts of West Yorkshire, and as a result, other hospitals in our area have been required to provide mutual aid and support. The uncertainties that this creates, along with the need for staff to undertake different ways of working on different sites, and the high levels of temporary cover, have created additional challenges.
The national job market for these specialist areas has also become more challenging and there is also a shortage of suitably qualified Advanced Care Practitioners (ACPs). Acute oncology, care for cancer patients who become unwell during treatment or because their disease had progressed is also under pressure.
In developing proposals for more robust services for the future, we have spoken to people affected by cancer (patients and carers) and people with an interest in cancer (staff) about what is important to them.
This includes:
- our Cancer Alliance community/patient panel
- medical and nursing staff in the hospitals where non surgical cancer care is provided
- independent experts from outside our region
They have helped us to develop some fundamental principles and we have worked alongside them to develop plans for the future. The most important of these principles was that care should be available as close to patients' homes as is practicable.
- What is important to you?
- What have we not thought of?
- How can we improve our ideas?
In Spring and Summer 2024 we undertook surveys in 18 different towns and cities across the region which showed a high level of support for each of the proposals. These are outlined below.
Drug Therapies
- All hospitals in West Yorkshire and Harrogate currently offering anti-cancer drug treatments will continue to do so.
- Patients will be allowed to choose to receive chemotherapy and other anti-cancer drugs outside of hospital settings, for example on mobile services or in your home supported by district nursing, where it is safe to do so.
- Patients with rarer cancers who have to travel to Leeds Cancer Centre for outpatient appointments will be offered the opportunity to have their drug treatments (like chemotherapy) from their local hospital, where safe and possible to do so ie for simple treatments.
Radiation Therapies
- Patients should not experience any significant change in radiotherapy services.
- Treatments will continue to be delivered from Leeds St James’ Hospital and doctors specialising in radiotherapy will continue to travel to local hospitals to deliver outpatient clinics for common cancers. There is a separate piece of work starting with colleagues in Leeds looking at expansion of radiotherapy services in the future.
Outpatient Clinics
- Services will be re-organised into two sectors, North and South. This merges some services and creates larger clinical teams which will be more resilient and offer a more equitable level of service.
- Outpatient clinics for the most common cancers will continue to be provided from each of the six hospital trusts. The most common cancers are lung, breast, colorectal (bowel) and prostate cancer.
- Outpatient clinics for rarer cancers will continue to be delivered from the Leeds Cancer Centre only (as is the case now).
- Outpatient clinics will be delivered by a combination of doctors and other cancer specialists such as senior nurses and pharmacists.
- Outpatient clinics will be delivered in a more standard and equitable way, using a combination of doctors and other cancer specialists such as senior nurses and pharmacists.
Inpatient Care
- All hospitals in West Yorkshire and Harrogate with an A&E department will continue to admit and treat patients who become unwell due to side effects of treatment or their cancer becoming more advanced.
- We will consolidate our specialist beds. Specialist inpatient beds will continue to be provided at Leeds St James' and Huddersfield Royal Infirmary.
- Most patients will be seen by at their local hospital by either the A&E medical team, a specialist acute oncology nursing team or another medical specialty – for example a cancer patient with a bowel obstruction would be seen by a surgical team.
- Bradford Hospital will continue to provide care for most complications of cancer but patients requiring specialist inpatient care will be transferred to Leeds Cancer Centre.
- Wakefield Pinderfields and Dewsbury Hospitals will provide care for most complications of cancer but patients requiring specialist inpatient care will now be transferred to Huddersfield Royal Infirmary instead of to Leeds St James. This provides for better continuity of care as it is oncologists from Huddersfield that will be responsible for the outpatient care of these patients.
- Where required, investment will be made to increase the size of acute oncology nursing teams to support patients to stay out of hospital/ have care as close to home as possible.
The consolidation of specialist inpatient care for people with cancer will free up doctors’ time for other clinical work such as outpatient clinics and to support chemotherapy
