ARC clinic reframes support planning for people living with treatable-but-not-curable cancer
People living with treatable-but-not-curable cancer often move through treatment with persistent symptoms, practical worries, and emotional strain that do not fit neatly into routine oncology visits. In that setting, a Holistic Needs Assessment can become either a meaningful clinical conversation or a box-ticking exercise, depending on when it is offered and how the encounter is structured. This quality improvement work set out to change that balance by using the ARC framework — Adversity, Restoration and Compatibility — as the basis for a new personalised care model.
The intervention was built around a simple but consequential idea: supportive care planning works best when it begins with the way patients themselves make sense of illness, not with a generic checklist. Clinical experience was used to translate the ARC framework into an intervention called the ARC HNA and a service-level structure called the ARC clinic. Patients and clinicians then shaped the content, delivery, and timing through involvement and engagement activities before the pilot began. This was not an abstract redesign of paperwork. It was a practical attempt to make personalised care feel clinically useful at the bedside.
Proactive assessment found a large burden of unmet need
The pilot enrolled 51 patients living on the TbnC pathway, including people with myeloma and metastatic breast, prostate, or lung cancer. Participants were 6 to 24 months into treatment, a phase in which the disease is still actively managed but cure is no longer the goal. In that interval, symptoms can accumulate, uncertainty can persist, and support needs can become more complex even when disease-directed therapy continues.
An average of 12 new concerns was identified per patient. That is a substantial burden for a population already embedded in specialist care. It suggests that ordinary clinic workflows may miss many of the issues patients are carrying between appointments, especially when conversations remain focused on scans, toxicity, and treatment sequencing. The ARC model created a protected space for patients to name those concerns and link them to actionable support.
96% of patients achieved at least one of their goals.
For a supportive care intervention, that figure matters because it suggests the discussion did not end with problem identification. Patients left with at least one concrete objective addressed through the care plan, which is the point at which a Holistic Needs Assessment begins to function as a clinical tool rather than a documentation requirement.
Reflection and follow-up changed the tone of the encounter
Patients valued the chance to pause, reflect, and return to the issues raised in follow-up. That response fits the structure of living with TbnC cancer, where needs are rarely static. Symptoms, uncertainty about the future, family demands, and treatment side effects may shift over time, and a single intake conversation can easily under-capture the broader picture. By building in follow-up, the ARC clinic allowed the assessment to unfold as a process instead of a one-off event.
Clinicians, in turn, valued the collaborative approach to supportive care. That matters because multidisciplinary agreement is often what determines whether a support plan is actually implemented. When the assessment is shared, specific, and timed to the patient’s disease trajectory, it becomes easier to coordinate symptom control, psychosocial support, and practical assistance across teams.
The intervention also reflects a pathophysiological reality of advanced cancer care: symptoms and distress rarely occur in isolation. Fatigue, pain, sleep disturbance, anxiety, and treatment burden can reinforce one another. A structured but flexible HNA creates a mechanism for identifying those interacting problems before they harden into avoidable crisis visits or unmanaged decline.
Care plan completion rose sharply compared with routine practice
The most striking operational result was the difference in care plan completion. Routine initial HNA and care plan completion rates stood at 13%, while the ARC clinic achieved 90%. That gap suggests the redesign altered more than patient willingness; it changed the clinical process itself. Timing, structure, and follow-through appear to have been critical.
The clinic also ensured that all care plans were shared with general practitioners. In a cancer pathway that spans oncology, primary care, and community support, communication failures can leave patients repeating their concerns or falling between services. GP sharing turns the care plan into a shared record of what matters to the patient and what has been agreed clinically, which should improve continuity when needs extend beyond the cancer centre.
These numbers point to a model that is more proactive than the usual approach to Holistic Needs Assessment. Rather than waiting for patients to surface problems during standard appointments, the ARC clinic built a dedicated service structure around assessment and action. The result was a higher yield of concerns, better goal completion, and far more reliable care planning.
A model built for patients who live with uncertainty
TbnC cancer creates a prolonged period in which patients live with active disease but cannot expect cure. That clinical reality often produces a different set of needs from early-stage oncology or end-of-life care alone. Patients may still be receiving treatment, still hoping for disease control, and still managing the daily consequences of a serious diagnosis. Personalised care has to work inside that tension.
The ARC framework seems well suited to that task because it gives clinicians a way to interpret patient narratives without flattening them into symptom lists. Adversity captures the burdens of illness, Restoration reflects attempts to recover function and stability, and Compatibility speaks to the effort to adapt life around cancer. Used in practice, those themes can guide a more meaningful assessment and make the resulting care plan more relevant to the individual patient’s stage of illness.
Implementation questions now move to scale and durability
This pilot shows that personalised care and support planning can be delivered with much greater consistency when it is embedded in a dedicated clinic model. The remaining questions are practical: whether the same structure can be sustained across services with different staffing and patient volumes, whether the gains hold over time, and how the model performs beyond the specific TbnC pathways included here. The intervention was tested in myeloma and metastatic breast, prostate, and lung cancer, so wider adoption will need to account for differences in disease course, treatment intensity, and clinic resources.
Even with those limits, the core signal is hard to ignore. A Holistic Needs Assessment linked to the ARC framework identified a large number of previously unmet concerns, helped nearly all patients achieve at least one goal, and markedly improved care plan completion compared with routine practice. For people living with cancer that is treatable but not curable, that kind of structure can change the clinical encounter from a cursory check-in into a documented plan for support.