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

I always considered (quite wrongly) that The Christie was a place where you go to die. How wrong I was! It's most definitely a place you go to live - Joan Campion

Joan Campion - Christie patient

Joan Campion

It's difficult to put into words exactly how you feel when someone tells you that you have cancer and I won't even begin to try to explain it - it's awful. Suffice to say that it resonates throughout your whole family and friends.

After my diagnosis with melanoma, things began to happen quite quickly. I was referred to The Christie and there began a journey which I shall always remember.

During my 71 years, I have been an inpatient in at least four or five different hospitals, but have never met staff with so much empathy before. From the consultant right through to Debbie, the dressings nurse, they were all considerate, supportive and warm-hearted. Importantly too, they answered my many questions intelligently and honestly.

I had my operation early in December 2014 and then had a traumatic wait for the results of the biopsy. I hoped to get the results before Christmas and thanks to the kindness of one of the nurses, I got a call from the specialist nurse practitioner just before Christmas with my results. The cancer hadn't spread and that was the most wonderful Christmas present I've ever had!

My joy was short lived however, because only days later my partner was diagnosed with metastatic prostate cancer, which unfortunately won't have the same positive outcome that I've had. But he's very philosophical and dealing with it with courage and positivity. I've been with him throughout his treatment and he has experienced the same warm support from all The Christie staff as I did.

It really does keep your spirits up when you're greeted with a smile and a cheerful disposition, when you can sit down with qualified staff and ask really difficult questions, sure in the knowledge that you will always receive truthful responses.

Before these experiences, I always considered (quite wrongly) that The Christie was a place where you go to die. How wrong I was! It's most definitely a place you go to live. I, and I imagine many other patients, can't sing its praises too highly. It's a remarkable hospital with remarkable staff!

I was surprised how everyone I asked from ticket collectors to taxi drivers spoke about The Christie with a sense of pride and gratitude - Omer Aziz

Omer Aziz - consultant colorectal and laparoscopic surgeon at The Christie

Omer Aziz

Just over a year ago, I made the decision to leave London, a city where I had lived for 26 years, and move to Manchester with my family. This came about because of the opportunity to join the Colorectal and Peritoneal Oncology Centre at The Christie as a consultant colorectal surgeon. 

It was the kind of career move you can't plan for, largely because there isn't a job like this anywhere else in the country, and perhaps only a handful of jobs like it in the world.

I remember my first trip here from London, where I was surprised how everyone I asked from ticket collectors to taxi drivers spoke about The Christie with a sense of pride and gratitude. It was endearing to see how this institution has touched so many lives. 

The next thing that would come up in my conversations about Manchester was football, with people passionate about either the 'red' of United or 'blue' of City. Being a Liverpool fan meant I had to try to avoid getting drawn into that discussion!

At The Christie I have joined a team offering highly specialised cancer surgery, performing procedures such as Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and advanced keyhole operations for cancer. CRS involves removing all visible tumours and is most commonly performed in cases of Pseudomyxoma Peritoneii (PMP), appendix cancers or colorectal cancers that have spread to the lining of the abdomen (peritoneum).  Once the tumours are removed, HIPEC is then inserted into the abdomen and circulated for about 90 minutes. This is a highly concentrated, heated chemotherapy treatment that unlike systemic chemotherapy (which circulates throughout the body), delivers chemotherapy directly to cancer cells in the abdomen. The solution is then drained from the abdomen and the incision is closed. The Christie is one of only two UK hospitals commissioned to do this type of surgery.

We work closely with plastic surgeons, urologists, and gynaecologists all specialising in cancer, which means we can perform complex cancer surgery involving multiple organs routinely. Through our radiology colleagues we have access to scanning resources and interventions that mean we can offer high quality opinions to our patients and second opinions to clinicians seeking our expertise.

But it is the simple attention to detail, teamwork, and treating patients with compassion that I think makes this the best hospital for cancer treatment that I have worked in. Visiting times are flexible on wards such as the critical care unit, which is so important to patients and their families. Once referred to The Christie colorectal and peritoneal service, patients are assigned a clinical nurse specialist and given a contact number to call if they have any questions and run into any problems. These nurses are experienced and offer reassurance as well as picking up any warning signs of potential problems. Today, a patient attended my clinic and told me that the thing she appreciated the most throughout her care here, was that her husband was called right after her operation was completed, to let him know she was ok. I have rarely seen this happen in other hospitals, yet it has been a standard practice amongst colorectal surgeons here.  While there are many ways we can improve, we have a strong platform on which to build - as long as our patients remain at the centre of what we do.

There was a really positive attitude amongst staff and patients and a real sense of pride to work at The Christie - Wesley Doherty

Wesley Doherty - Christie Radiographer

Wesley Doherty

I got into radiotherapy a bit later than most. I've always worked in healthcare and fancied a new challenge. Radiotherapy certainly provided that!

I completed the postgraduate diploma in radiotherapy at the University of Liverpool in 2014, having worked as an optometrist for 15 years. My previous degree allowed me to apply directly to the university for the postgraduate course, but there is also an undergraduate degree programme accessed through UCAS.

I've always liked the combination of the technical physics side of things combined with the biology and pathology from my previous career, and radiotherapy was a natural, if not obvious, progression.

Even though I am accustomed to dealing with difficult and upsetting news for patients and I talk a lot, which comes in very useful as a therapy radiographer, I was a bit worried about working in a cancer hospital. I wrongly assumed it would be a really difficult environment to work in.

I needn't have worried. On walking through the door on the first day I was met with an overwhelmingly friendly atmosphere. There was a really positive attitude amongst staff and patients and a real sense of pride to work at The Christie.

I felt part of the team from the very start. I was supported throughout my training from day one by staff members, mentors and clinical tutors. This support didn't end when I qualified and I was assigned a mentor under The Christie's preceptorship programme for staff new to the trust. This is something I would really have appreciated in my previous career! Since then I have been a mentor myself to two students, one each at undergraduate and postgraduate level.

There is a real emphasis on progression and delivering your best at The Christie. My team is made up of radiographers, senior radiographers, superintendents, specialist and lead grades with opportunities to progress to site-specific roles such as colorectal, breast, paediatric and prostate specialist radiographers.

Since qualifying last year I have spent time in pretreat, treatment prep and treatment delivery. There are regular professional development events to keep up to date in a rapidly developing and highly technical field. With the recent groundwork beginning on the upcoming high energy proton beam therapy centre (one of only 2 NHS facilities in the country) this opens a completely new avenue of opportunities to pursue in the future.

In the past year, I have been encouraged to get involved in helping to shape the culture of The Christie. In my role as a Christie commitment champion, I am part of a team of staff from across the whole organisation who attend meetings in London aimed at transforming the culture of The Christie and the NHS. I hope to continue progressing by applying for funding for my master's degree in the next couple of years.

Working with cancer patients is a privileged position. Every day is different. Every day is rewarding. Every day is filled with new thank you cards and a never ending supply of chocolates, cakes and other goodies. Every day I get to know the wonderful patients I see better and better. Every day I smile more than I have done in any other job, and every day I feel like I am doing something to make a big difference to the patients.

Have you thought about a career as a therapy radiographer working in radiotherapy?  If you are interested in finding out more details, please email RTEducation@christie.nhs.uk