Wednesday 23 September 2015

Men living with and beyond prostate cancer can often have a range of medical and psychosocial needs, including the fear of cancer recurrence - Helen Johnson

Helen Johnson - prostate cancer clinical nurse specialist

Helen Johnson
Prostate cancer is the most common male cancer in the UK with over 40,000 new cases per year. The numbers of men are increasing and it has been estimated that by 2030, it will be the most common cancer of all.

Encouragingly, more men are surviving prostate cancer with 84% of prostate cancer patients surviving more than 10 years after treatment. However, this means that men living with and beyond prostate cancer can often have a range of medical and psychosocial needs, including the fear of cancer recurrence. It is therefore really important for us at The Christie to not only support men through the initial treatment phase, but to look with a focus on recovery and getting their lives back on track and preparing them for discharge.

Initial treatment comprises surgery, radiotherapy, hormone therapy or a combination of these. Standard aftercare has always been delivered at the main Christie site in Withington or a combination of appointments at The Christie and local hospitals. As The Christie serves a large catchment area, patients may have to travel long distances which can add cost and time pressures to patients and their families.

Because the numbers of patients are increasing, more outpatient appointments are required to deliver the aftercare which places increasing pressure on already stretched cancer services. If you have ever visited The Christie outpatients department, you will see that it is extremely busy with long waiting times and patients often don't get much time with their doctor to talk about some of the issues they may have after treatment. The Christie team was determined to find new ways to address this.

National guidelines recommend that two years after prostate cancer treatment has been completed, patients' aftercare should be given 'outside of hospital'. At The Christie we feel that a focus on holistic care delivery and local access was essential in this. The Christie therefore worked in partnership with the charity Prostate Cancer UK to undertake a pilot using a prostate cancer clinical nurse specialist working across primary and secondary care to deliver aftercare to prostate cancer patients. I was that lucky nurse!

I initially started by identifying geographical areas in Greater Manchester with high populations and prevalence of prostate cancer. I then identified primary care centres, GP practices or cancer centres in these areas that would be willing to let us have a room there for a nominal charge in which we could see patients. We developed patient information letters and information leaflets and invited men who had completed treatment to attend community based clinics instead of their standard hospital based check-up appointment.

My focus in the clinic appointment is to assess patients physical and emotional needs and offer advice as to how to deal with the consequences of the treatment they have. Patients receive more time per consultation, and broader issues such as lifestyle advice and management of symptoms associated with treatment are addressed along with standard monitoring for recurrence. Fast track referral back to The Christie hospital is available if required

The community service has now been accessed by over 1,000 men, releasing more than 1,600 hospital based appointments. This in turn freed up resources within the main Christie site to focus on supporting patients with more complex needs and new referrals. I have collected information on all of the clinic appointments as well as patient satisfaction surveys. Men identified a number of issues as a consequence of their treatment. 30% had bowel trouble, 34% had water work problems, 48% had sexual problems and12% had emotional issues. These were dealt with in the community clinic or by onward referral to other support agencies. One of the main aims of the clinic is to empower men to be able to self-manage and prepare them for discharge, and so far around 18% of men we see feel confident to manage their own blood tests and symptoms with the support of their GP. All men who attended the clinics rated it 'good' or 'very good' and found that access to the clinics and waiting times were much improved.

I am very proud of this innovative new service in prostate cancer care . We believe that the success of this service to date provides evidence of the effectiveness of this approach and we are now sharing our learning and experience for the benefit of the wider NHS.

If you want to find out more please contact helen.johnson@christie.nhs.uk

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