BRINGING CANCER TREATMENT DIRECTLY TO PATIENTS: REDESIGNING THE UK CARE SERVICE MODEL FRANCES LAWTON PROJECT MANAGER, CHEMOTHERAPY DIRECTORATE CLATTERBRIDGE CANCER CENTRE (UNITED KINGDOM) UKIE-NP-162X-1016-039705 . OCTOBER 2016 . AMGEN LTD HAVE SPONSORED THIS PRESENTATION WITH MEDICAL WRITING SUPPORT AND MEDICAL REVIEW THE CLATTERBRIDGE CANCER CENTRE NHS FOUNDATION TRUST Our vision: To provide the best cancer care to the people we serve • One of the UK’s largest networked cancer centres • Provides non-surgical oncology services to a 2.3million strong population • 8,000 new patients registered each year • 220,000 patient contacts for appointments and treatments • Care provided at base and through 16 peripheral sites across the region • Clatterbridge Cancer Centre NHS Cancer Treatment at Home launched 2015 Foundation Trust, North West England Provided October 2016, as part of an oral presentation and is qualified by such, contains forward-looking statements, actual results may vary 2 materially; Amgen disclaims any duty to update. CANCER TREATMENT AT HOME: SERVICE RATIONALE • Bring treatment closer to home • Improve the patients’ experience • Reduce pressure on busy clinics £170 average monthly spend on travel £37 average monthly parking cost Provided October 2016, as part of an oral presentation and is qualified by such, contains forward-looking statements, actual results may vary 3 materially; Amgen disclaims any duty to update. SELECTING THE APPROPRIATE SERVICE MODEL Home delivery Cancer Mobile Third party Chemotherapy of oral treatment at chemotherapy homecare in GP surgery chemotherapy home Provided October 2016, as part of an oral presentation and is qualified by such, contains forward-looking statements, actual results may vary 4 materially; Amgen disclaims any duty to update. SELECTING THE APPROPRIATE SERVICE MODEL Home delivery Cancer Mobile Third party Chemotherapy of oral treatment at chemotherapy homecare in GP surgery chemotherapy home Provided October 2016, as part of an oral presentation and is qualified by such, contains forward-looking statements, actual results may vary 5 materially; Amgen disclaims any duty to update. PHARMAC AT THE CLATTERBRIDGE CANCER CENTRE PharmaC – a wholly owned subsidiary of the Clatterbridge Cancer Centre Improves financial viability of Cancer Treatment at Home service Medicines supplied by the pharmacy for home use are VAT free Savings are reinvested in improving and expanding services Provided October 2016, as part of an oral presentation and is qualified by such, contains forward-looking statements, actual results may vary 6 materially; Amgen disclaims any duty to update. DEVELOPING THE SERVICE MODEL Set up executive Develop robust Consult and agree team to drive protocols to ensure nursing role implementation high levels of care Develop robust IT Identify appropriate Source funding to systems to manage therapies for support service and track inclusion in service redesign appointments Map potential Engage with number and Service launched stakeholders for frequency of April 2015 project support appointments Provided October 2016, as part of an oral presentation and is qualified by such, contains forward-looking statements, actual results may vary 7 materially; Amgen disclaims any duty to update. PHASED INTRODUCTION OF CANCER TREATMENT AT HOME • Phase I Wirral – administration of all identified treatments as per patient need – Trastuzumab – Trastuzumab + denosumab + bloods – Denosumab + bloods – Denosumab + fulvestrant + bloods – Denosumab + goserelin + bloods – Fulvestrant + goserelin + bloods – Goserelin • Phase II Merseyside and Cheshire – administration of all identified treatments as per patient need • Phase III – Pembrolizumab – Compassionate use Provided October 2016, as part of an oral presentation and is qualified by such, contains forward-looking statements, actual results may vary 8 materially; Amgen disclaims any duty to update. HOW THE SERVICE WORKS Patient Enrolment Treatment administration • Communications campaign to patients to coincide with • Average eight home visits a day depending on geography the service launch and treatment type • Once stable on treatment patients can opt-in to Cancer • Small fleet of Clatterbridge owned vehicles used as Treatment at Home or continue care in hospital transport • Service model ensures important milestones such as • Nurses employed directly by Clatterbridge and use treatment reviews, scans and blood test continue to take networked clinics as a base place as per CCC protocols • Patient satisfaction surveys introduced in summer 2015 and repeated annually Provided October 2016, as part of an oral presentation and is qualified by such, contains forward-looking statements, actual results may vary 9 materially; Amgen disclaims any duty to update. SERVICE STATISTICS 10-15 15-30 30-45 45-60 60 % of patients patients of % 0-15 15-30 30-45 45-60 60 years Provided October 2016, as part of an oral presentation and is qualified by such, contains forward-looking statements, actual results may vary 10 materially; Amgen disclaims any duty to update. RESPONSE TO CANCER TREATMENT AT HOME Patients report 100% satisfaction and 100% staff met the patients’ needs Zero patients reporting to triage or A&E due to problems following treatment 139 patients enrolled 2,700 treatment episodes and associated clinic time saved £257,898 VAT saving 84.6% of monthly CIP (Cost Improvement Programme) target achieved Provided October 2016, as part of an oral presentation and is qualified by such, contains forward-looking statements, actual results may vary 11 materially; Amgen disclaims any duty to update. CANCER TREATMENT AT HOME: PATIENT COMMENTS Provided October 2016, as part of an oral presentation and is qualified by such, contains forward-looking statements, actual results may vary 12 materially; Amgen disclaims any duty to update. COMPASSIONATE USE - NOVEL USE OF TREATMENT AT HOME Patient 1 • Patient demographic: male, 27 • Physical capacity: severe autism and learning difficulties, lacks mental capacity, requires 24 hour care • Health need: weekly bloods to monitor tumour markers Patient 2 • Patient demographic: female, 86 • Physical capacity: elderly, frail, only support is son with mental and physical health issues • Health need: denosumab injections Provided October 2016, as part of an oral presentation and is qualified by such, contains forward-looking statements, actual results may vary 13 materially; Amgen disclaims any duty to update. CHALLENGES TO SERVICE DEVELOPMENT • Incompatible IT infrastructure at CCC peripheral sites • Toxicity management of complex treatments • Opt-in versus opt-out service Provided October 2016, as part of an oral presentation and is qualified by such, contains forward-looking statements, actual results may vary 14 materially; Amgen disclaims any duty to update. SUMMARY Key considerations: • Cancer Treatment at Home has improved patient Do not under estimate the time, resource and culture change required experience of cancer care at the Clatterbridge to develop and implement new Cancer Centre NHS Foundation Trust services Engage with and consider the needs • Corresponding benefits to clinic capacity have of all relevant stakeholders been observed Maintain high levels of communication with the wider team • Cost savings have been delivered by utilising in order to maintain project in-house pharmacy services momentum Investigate sources outside of the • The service model can be adapted and Trust for grants or funding for service expanded to include additional therapies and redesign Build in measures to evaluate patient patient populations responses from the outset Provided October 2016, as part of an oral presentation and is qualified by such, contains forward-looking statements, actual results may vary 15 materially; Amgen disclaims any duty to update. BRINGING CANCER TREATMENT DIRECTLY TO PATIENTS: REDESIGNING THE UK CARE SERVICE MODEL FRANCES LAWTON PROJECT MANAGER, CHEMOTHERAPY DIRECTORATE CLATTERBRIDGE CANCER CENTRE (UNITED KINGDOM) .