Excellent Practices

Supportive Oncology

Practice Category: Treatment

Centre: The Christie NHS Foundation Trust

The rising incidence of cancer signals a deepening clinical and societal challenge. In the UK, the number of people living with cancer will rise from 3.5 million in 2025 to 5.3 milliion by 2040. The impact will extend across the healthcare system, escalating demand not only for cancer therapies but also for care related to treatment- and disease-associated complications.
Supporting people through treatment is becoming increasingly complex, compounded by longer treatment duration, prompting a need to rethink the clinical pathway in cancer care.
A significant proportion of Emergency Department (ED) admissions for oncology patients are due to uncontrolled pain, disease- or treatment-related toxicities. These represent a failure in the continuum of care and expose gaps in current service models. Many of these acute presentations can be managed/prevented upstream in an outpatient/ambulatory setting, reducing the economic impact of unplanned oncology care, as well as enhancing patients’ quality of life.

Supportive oncology is the management of chronic and emergent problems in people living with and beyond the disease. It encompasses the entire cancer spectrum and has developed in response to the changing patient demographic.
Optimal supportive oncology requires input from a myriad of medical and non-medical specialties – a “pyramid of provision”– with supporting services working in an integrated way.
It is delivered through daily open-access multiprofessional Enhanced Supportive Care (ESC) clinics (so patients have rapid on-site or remote access to expertise in management of disease- and treatment-related toxicities), a weekly supportive oncology MDT, onco-endocrinology, psycho-oncology and senior adult oncology clinics, and a unique dedicated supportive oncology directorate within the hospital management structure which houses all medical and non-medical supportive cancer services.
The clinical services are underpinned by a nationally recognised supportive oncology clinical fellows training scheme and a programme of supportive oncology research.

Supportive oncology has been shown to improve symptom burden, reduce chemotherapy deferrals, reduce secondary care use, and provide a financial saving to the NHS, which proves this model to be sustainable in achieving superior outcomes for patients with cancer. Whilst ESC clinics have traditionally catered for the needs of patients with treatable but not curable cancer, the cost saving from the reduced end-of-life year costs in one study was large enough to pay for the care of all patients, including those not in the last year of life.
A multicentre study examining the economic impact of supportive oncology services in UK cancer centres found that Enhanced Supportive Care (ESC) significantly reduced costs in patients with treatable but incurable disease. Across a 12-month period between 2021 and 2022, £1.6 million was spent delivering ESC across eight UK centres. Reductions in secondary care usage for 1,061 patients saved £ 8.5 million.

The concept of supportive oncology in the UK originated from specialists at The Christie, who developed the model of Enhanced Supportive Care (ESC). Support from the Trust board, from its inception, was crucial to its success.
The model was subsequently adopted and funded by NHS England and tested in a further 20 cancer centres.
In 2025, both the Royal College of Physicians and The Royal College of Radiologists released press statements calling for the development of standardised clinical pathways in supportive oncology, supported by an expanded workforce, closer integration with oncology, and the development of outcome metrics. This recognition of the core value that supportive oncology brings to cancer care has represented a significant milestone. The report also identified rising complex need, coupled with medical training that is falling behind, supportive oncology not yet embedded in training curricula, a need to strengthen workforce training, and standardisation and improvements in clinical practice.

Specialists from The Christie have been working with government to help define the steps required to ensure that supportive oncology becomes standard practice across all UK cancer centres over the next 10 years. This work will form part of the new UK cancer plan (due to be released in early 2026).
Work is also underway to identify key effective components and optimal models of care. This will, in turn, help simplify business case planning and provide clarity in terms of service commissioning.