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Enhanced Supportive Care makes excellent cancer care possible – Dr Richard Berman

Enhanced Supportive Care is a new initiative aimed at addressing more fully the needs of cancer patients – in particular, preventing and managing the adverse physical and psychological effects of cancer and its treatment. Here, National Clinical Lead for the programme, Dr Richard Berman, sets out how the initiative was developed and what it means for patients and professionals alike.

Cancer is changing. With better treatments, more and more people are surviving, or living longer than ever before.

And as a palliative care consultant in a busy cancer centre, this means that my role has changed too.

I still work hard to ensure excellent care for patients at the end of their lives; but increasingly, I help patients much earlier, during their cancer treatment, by providing specialist care to manage their pain and symptoms. This means that we actually help patients to get through their cancer treatments, in a positive way.

And in fact, evidence from around the world shows that earlier involvement of supportive and palliative care in cancer care results in better outcomes for patients, including the potential to extend their survival.
This represents a real opportunity for palliative care. But if we want to be part of cancer care earlier, does the term ‘palliative care’ still fit?

I think it doesn’t matter where patients are in their cancer journey, people always need hope. They need to feel that the health professionals looking after them are working with them in a positive way, and doing their best to keep them feeling as well as possible, for as long as possible.
So we needed a very positive vision; a new approach to delivering palliative care in a cancer centre.

So how about the term ‘Supportive Care’?

“Supportive care” is the management and prevention of the adverse effects of cancer or cancer treatments. At The Christie NHS Foundation Trust we developed this into “Enhanced Supportive Care (ESC)”, a new initiative that promotes the earlier integration of supportive care within cancer care.

There are 6 principles:

  1. Much earlier involvement of supportive care services in cancer care
  2. Teams that support cancer patients should work more closely together
  3. We should adopt a much more positive approach to supportive care
  4. Cutting edge and evidence-based practice in supportive and palliative care
  5. Technology to improve our communication and way of working
  6. Best practice in care of patients undergoing chemotherapy

And we’ve taken some bold (but simple) steps to make this work.

We have “re-branded’ our palliative care team to the “supportive care team” to help break down the barriers to achieving earlier involvement of palliative care expertise.

We have worked much more closely with our oncology teams, in their clinics, and on the wards.

We have focussed much more on minimising the side effects of supportive care treatments and provide up-to-date pain and symptom management – not only to improve and maintain quality of life, but also to help patients through their chemotherapy treatments.

And we not only support patients with advanced cancer, but also those who are living with cancer as a long term illness and cancer survivors.

The work we have done around integration with oncology and early intervention has increased patient and carer satisfaction, reduced hospital admissions and most importantly, given patients hope.

ESC has been recognised nationally by NHS England, and received a national QiC (Quality in Care) patient care pathway award in February 2016.

Now, I’m delighted to be able to play a role – as National Clinical Lead – in encouraging and supporting more cancer centres to adopt this kind of approach. As part of this, we have recently produced guidance for providers and professionals which will help them think about how they identify and meet the changing needs of cancer patients as they go through their treatment journey.

Cancer can take a huge toll on those who are living with it, whatever their prognosis. But as this programme is phased in over the coming months and years, I am confident that we will be doing the best we can to reduce that toll for thousands of patients.


Dr Richard Berman FRCP is NHS England’s National Clinical Lead for Enhanced Supportive Care, and a Consultant in Supportive & Palliative Care based at The Christie NHS Foundation Trust.

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6 comments

  1. Sarah says:

    In re-branding the Palliative Care Team was there any negative feedback or impact for non cancer services or do you have clearly defined support for both?

  2. Pawan Randev says:

    Dear Dr Berman
    This is a great concept – I wonder how primary care can be included? Our patients often ask us as their GPs if they should have suggested treatments. Our discussion is based on our previous knowledge of the patient and their wider circumstances and values, so tries to reflect a holistic view.
    Great communication from the cancer centre is essential to give us a true sense of the balance of cost and benefit to the individual. It feels to me that a parallel approach that uses the established relationships between patients and their practices, can deliver this approach in the community and support patients and their families.

  3. frankie says:

    how do we cite your article

    • Richard Berman says:

      Frankie – you can cite this as a blog within the NHS England website and copy the weblink.
      Thanks, Richard

  4. Pierre Landell-Mills says:

    Where is “Enhanced cancer care” as you describe it in place in Devon? Good intentions are fine, but what counts is what is actually happening to patients right now.