Tuesday, 19 February 2019

Protons coming home to Manchester - Hazel Pennington

Hazel Pennington, The Christie

Hazel Pennington
I wasn’t around when Ernest Rutherford first discovered protons at Manchester University in the early twentieth century. However, 100 years later I have the privilege and amazing opportunity to be involved in developing the first UK NHS high energy national proton service at The Christie in Manchester.

My journey started in 2014 as the lead radiographer in the project. In fact, I was the only radiographer for a few years. This may have been viewed as a challenge in a profession where we usually work in radiographic teams, but I thrived on the opportunity to work closely with other professions. 

Initially, I worked with the clinical lead, a consultant clinical oncologist, the head of physics and the lead engineer. We all got to know each well after many hours spent together in meetings, on trains to London, on long-haul flights to conferences and overseas hospitals, and evenings out in a new city talking about what we had seen and learnt that day about protons and our vision for the future. Unbelievably, we all still get along!

As well as my clinical and physics tag team, I worked with project managers, lawyers and the finance department to acquire the proton equipment. Proton equipment procurement has a reputation for litigation, and for some countries, legal challenges have significantly delayed their progress. The team worked hard to ensure a smooth process and to avoid legal challenges. The learning curve was huge and I was often in overdrive: not only were protons new to me, but the project processes were also new.

Next to learn about were concrete and cranes! Who would have thought as a student radiographer that 25 years later I would be discussing the logistics of the crane size needed to get an 90-tonne cyclotron (the bit of equipment that generates the actual protons) into place and how we needed part of the external wall removing on the first floor to get the MRI scanner into place as it was too large for the corridors. I now know what a ‘crane oversailing license’ is (a license allowing a tower crane to oversail property adjoining the site) and that a ‘joggle joint’ ensures each concrete element locks together securely to prevent radiation leakage at stop ends. I spent many an hour with architects, engineers, the construction team and designers.

Did I lose sight of the patient in all this project work, I hear you ask? I hope not. I created a patient representative group of patients, from children to octogenarians and their carers, who had received proton therapy overseas. They blew me away. I can’t find the words to describe how incredible they were. They gave up their free time to explain what it was like being away from home for a couple of months for treatment, the best type of accommodation, how to keep up with school work, ideas for how the centre should feel and look, and the best types of patient information. 

We took all this vital information on board and have hopefully created a patient-centred service, which includes every patient having a named key worker (specialist nurse or radiographer) who telephones patients before they arrive for their first appointment (talking was the best type of patient information). 

Only this week, I was gratified to hear that one of our five-year-old proton patients on his first visit said the centre was the ‘best place ever’ and he couldn’t wait to come back next week to show his mum. Ultimately, everything we do as healthcare professionals should be about the patient.

How do I feel now the service is operational? Exhausted! 

Seriously, first and foremost I am immensely proud of everyone who worked tirelessly to start the service. The success of the project has been down to the hard work and collaborative working of the whole team. It is one of the aspects of the project, and now operational service, that I enjoy the most. We have a close team, not only of radiographers, physicists and doctors but of nurses, theatre practitioners, anaesthetists, support workers, secretaries, play specialists, allied health professionals, social workers, MDT co-coordinators, complementary therapists, governance officers and domestic staff. 

They are all, without exception, brilliant. I have a huge amount of knowledge and respect for the other professions. I’ve learnt a lot from my co-workers and I take great pride in calling them, my colleagues.

Thursday, 3 January 2019

The ‘C’ Word - Richard Jackson

Richard Jackson, Christie cancer survivor

Richard Jackson
There are some words that are always hard to hear, let alone say, but for many of us, living with cancer is a reality we can’t avoid. Conversations with the ‘C’ word are inevitable.

When I was diagnosed with stage 4 malignant melanoma (a type of skin cancer) I was offered the opportunity to join a clinical trial at The Christie. There were no other alternatives to treat my cancer at this advanced stage, so it wasn’t a difficult choice to make. If the trial wasn’t going to benefit me, perhaps some of the findings would help to develop more effective treatments in the future.

My initial trial was unsuccessful, the treatment I was taking had reduced the swelling in my lymph nodes in my neck, however the tumours around my body, just under my skin, were growing both in size and number.

The next conversation I had with the specialist registrar was probably the hardest I’ve ever had to have. The bare facts were presented to me and as far as he could see there was nothing else that could possibly be done. In his words, “It was time to face my own mortality.”

What is amazing about being a Christie patient is the fact that the doctors, nurses and other support staff don’t give up easily. They gave me the hope to try and face my future and find other options that might be beneficial. I was still strong physically and prepared to consider whatever could help me remain an active part of my wife and young family’s lives for as long as possible.

The chance to use a new style of cancer treatment was offered to me, an immunotherapy drug. It had been on trial at The Christie, but I was allowed access to it as a therapy. I really needed to have the comfort that I had tried everything so I jumped at the chance to trial the new drug.

Incredibly, within 24 hours of my first treatment, my tumours had reacted and changed. They were no longer dark and sinister but had changed to a flushed red.

My wife is still convinced she watched a large tumour in my neck slowly reduce as we sat watching a film. Not wanting to get carried away, we visited my consultant, I remember explaining what we could see, and saying, ‘I don’t want to get too excited, but…’

The response, once the evidence of my tumours reducing was obvious to my consultant, is one I’ll never forget: “Let’s all get very excited.”

Five cycles of treatment later, and after enduring some unpleasant side effects, I was clear of cancer. The last of my treatments was on my 40th birthday, in 2008. This year I celebrated my 50th birthday with my family, 10 years cancer free and living a normal life.

Thanks to The Christie, the ‘C’ word I can use now with confidence isn’t cancer, it’s cured.