The purpose of Scottish Cancer Clinical Management Pathways is to outline the patient journey from diagnosis onwards. These describe the pan-Scotland consensus on treatment options at the various points in patient’s pathway to support shared decision-making. The development of national Clinical Management Pathways (CMPs) will support equity of care across Scotland. Creating a single, coherent CMP for each tumour site will provide trusted, timely, and robust resources for NHS professionals. 

Clinical Management Pathways are consensus documents that look to:

• Standardise treatment approach/intent across Scotland.
• Incorporate appropriate evidence-based practice where appropriate
• Signpost to existing or external guidelines/support/services
• Streamline or summarise processes or pathways into an accessible format
• Collate single technology medicine appraisals into coherent peer approved pathways
• Document agreed peer approved process or pathway where there isn’t a robust evidence base for practice.

Clinical Management Pathways are not rigid clinical guidelines, nor do they seek to rewrite or review existing evidenced based guidelines or practice.

Clinical Management Pathways have been developed by clinicians and represent clinical consensus on best standard of care for cancer patients within NHS Scotland. Where relevant, these pathways incorporate national advice or guidance on treatments such as health technology appraisals from the Scottish Medicines Consortium and the National Cancer Medicines Advisory Group, SIGN guidelines, and other Scottish or UK wide clinical guidance or recommendations. They have been developed to support equity of access and minimise unwarranted variation in practice.  
 
Whilst these pathways represent a unified clinical consensus on the treatment and management of cancer, it is well recognised that implementation of new treatments or approaches may take time, additional resource or service re-design. The ability to deliver individual components in the pathways may differ between individual Boards or Networks depending on local resource and capacity. It is therefore important to acknowledge that the inclusion of a treatment or approach within these pathways is not a guarantee of immediate access. The CMPs help to ensure a consistent direction of travel across Scotland and aims to assist regional networks and Health Boards in identifying service delivery areas for prioritisation or improvement.  

Currently there is no mechanism in place to review regional network or Board ability to deliver the pathways. The Scottish Cancer Network does not seek to add additional monitoring or reporting requirements around the delivery of CMPs. Instead SCN will work closely with the National Cancer Quality Programme to progress future alignment of QPIs with CMPs and working with patients, clinicians and the networks to ensure measurement of appropriate and relevant quality patient outcome measures. There will also be opportunities to work with the Cancer Medicines Outcomes Programme, the national SACT Data group and other key stakeholders to explore how best SACT prescribing data can be used to determine where SACT is adding the most value and benefit for patients. Any such use of prescribing data will be fully co-designed with clinicians, and where appropriate, with patient group representation. 

CMPs are designed for Healthcare Professionals involved in the management of cancer. A separate website is under development aimed specifically at the needs of patients and carers. The Breast Cancer CMP material has currently been piloted with Lung and Adult Nero content to follow. You can access this site at the following address: https://www.scottishcancernetworkpatientinfo.nhs.scot/ 

The clinical content on RDS is password protected and will be updated on a regular basis. Healthcare Professionals who would like access to the CMPs should register through this form to receive password information and essential updates regarding the content and platform.

 The password and the content of the password protected CMPs should not be shared.

The first three CMPs were developed during an extensive scoping and development project phase, which included extensive consultation with both clinicians and regional networks. The diagram below outlines how the initial content will be developed for new CMPs moving forward building on initial CMP development experience. The process is divided into phases and then each phase into several stages. 

During initial CMP development, a clinical lead for that tumour speciality is appointed to provide clinical leadership and support throughout the development phase. For each chapter or section within the CMP (e.g., diagnostics, surgery, radiotherapy, SACT etc), a subgroup will be established to lead on that specialist area. There is an open invitation for all clinicians (including medical, pharmacy, nursing, Allied Health Professions or others as appropriate) working within cancer services to participate in the development of the content. Representation from across Scotland will be actively sought for each subgroup, with an absolute minimum of one clinical representative per regional network.

Access to medicines: The pathways will not make recommendations that contradict medicines policy, SMC or NCMAG decisions or make recommendations where an SMC or NCMAG submission should be made. There may be rare occasions where an indication or medicine may be considered clinically valuable, but does not meet the criteria to be assessed by either SMC or NCMAG. Currently, local Health Boards and Regional Cancer Networks have processes in place to address these gaps, either on an individual patient or a population basis. SCN will not make any recommendations that bypass the need to follow local or regional governance processes around medicines access. Clinical gaps may be acknowledged in the pathways, but these do not constitute a recommendation on a specific course of action and there will always be a re-enforcement that clinicians must follow local or regional process. In such rare cases that are identified, SCN are committed to work with key stakeholders to try and find a national solution or way forward in addressing these gaps.

Following content development, a further clinical consultation will be circulated to all relevant clinical groups or networks, prior to finalising collated content for regional network consultation.

Following consultation and feedback, final amendments will be agreed with clinical subgroups as appropriate prior to publication. An editorial group is being established to support internal governance and review of content prior to publication as well as support the ongoing maintenance and update of existing CMPs. 

Figure 1: Snapshot of the CMP process development, phases and stages.

If you have any questions about the CMP development, please contact the Scottish Cancer Network at nss.scottishcancernetwork@nhs.scot for more information.

Disclaimer

Consensus documents hosted in this toolkit are not a rigid constraint on clinical practice, but a concept of good practice against which the needs of the individual patient should be considered. It therefore remains the responsibility of the individual clinician to interpret the application of these guidelines, taking into account local service constraints and the needs and wishes of the patient. It is not intended that these consensus documents are applied as rigid clinical protocols.  

Copyright 

Unless otherwise indicated, copyright of the content in this app/website is retained by Scottish Cancer Network. Users may download or print copies for their own use and may photocopy consensus documents for the purpose of implementation. 

Scottish Cancer Network allows for copying and redistribution of Clinical Management Pathways as long as Scottish Cancer Network is being acknowledged and given credit and as long as it’s for the intended audience (see intended audience section for further information). The material must not be remixed, transformed or built upon in any way.

Users wishing to use reproduce or republish Clinical Management Pathways for commercial purposes must seek prior approval for reproduction in any medium by contacting the Scottish Cancer Network at nss.scottishcancernetwork@nhs.scot.

Links to other websites and applications  

The provision on this app/website of a link to another website or application does not constitute any authorisation to access material held at that location. Links to sites are provided for informational purposes only and no responsibility is accepted for the quality of resources to be found on such websites. The contents and material made available on linked sites are completely out with our control and as such no liability is accepted for any damages resulting from accessing or failing to access these sites. No endorsement is expressed or implied by the presence of a link on this app/website. The contents of a linked-to website may change without our knowledge and as a result, links may break or may terminate on pages which were not the original targets of a link. No responsibility or liability for the privacy of personal information is accepted for linked to websites, as these are beyond our control.  

Each overarching CMP will undergo full review a minimum of every 3 years.

Individual chapters/sections may undergo update or review independently of the full CMP review. The frequency of any such update will be driven by clinician request or change in national or clinical policy or practice that impacts that section. Some areas will be subject to more frequent review e.g., SACT and new medicines advice from the Scottish Medicines Consortium or the National Cancer Medicines Advisory Group.

Updates will be issued no more frequently than quarterly, and this process will be reviewed regularly.

If you would like to request a content update, please complete the following form.

Schedule for feedback:

SCN welcomes feedback on the CMPs, including content, usability and any suggestions for future consideration. If you would like to provide us with feedback on the CMPs, please complete the following form.

SCN will review all feedback received on a regular basis through the CMP editorial group.

Additionally, SCN will seek more structured feedback on the CMPs through a user survey once they have been in use for a reasonable amount of time. 

Content has been checked for accessibility in line with the relevant RDS standard operating procedure

Link to:  Accessibility statement

Link to: Browser and device compatibility statement

These statements are provided by Tactuum Ltd, the company which provides the underpinning technology for the Right Decisions platform.

AbilityNet has advice on making your device easier to use if you have a disability.

The Scottish Cancer Clinical Management Pathways are available through the RDS app which is available to download to Android and iOS devices.

Once you have downloaded the app you will also be able to install the  Scottish Cancer Clinical Management Pathways "toolkit" which gives access to this content as well.