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, 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, delivering as much cancer care as possible closer to home, 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.
- What is important to you?
- What have we not thought of?
- How can we improve our ideas?
In January 2024 we undertook surveys in seven different towns and cities which indicated a high level of support for the proposals. These are outlined below.
Drug Therapies
- All existing chemotherapy day units will remain open. We will also review the opening hours of each and look to offer more evening or weekend treatment slots.
- More treatment options will be available outside of hospitals. This could be in your home, in community locations such as GP surgeries or on mobile services.
- There will be more opportunities to have treatment close to your home. Wherever possible patients will be offered treatment at the closest unit to their home, even if that is not the hospital you attend for you outpatient appointments.
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.
- ALL Trusts will offer clinics for patients with the most common cancers. These are lung, breast, colorectal (bowel) and prostate cancer.
- Not all hospitals will offer clinics for rarer cancers, these will continue be seen and treated at the Cancer Centre in Leeds (as is the case now).
- More clinics will be undertaken by specialist nurses and pharmacists.
Inpatient Care
- All hospitals with an Accident & Emergency department will admit acutely unwell cancer patients.
- 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.
- We will consolidate our specialist beds. In the south this will be at Huddersfield Royal Infirmary, with options on how to best do this in the north underway between Bradford and Leeds for patients requiring specialist inpatient care.
- 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
