NNUH head and neck cancer team are bringing services closer to home for their patients living on the coast with the launch of two clinics at Cromer Hospital.
The Norfolk and Norwich University Hospitals team comprises Erica Everitt, Senior Matron for Head and Neck Cancer Services and Tracheostomy Support Services, and Head and Neck Specialist Nurses Cristina Fernandes, Astra Rutherford-Hall and Helen Goward with Cristina and Astra’s roles originally funded by the Macmillan charity. They run two parallel clinics: One is a nurse-led clinic focusing on general well-being, ongoing assessment, giving advice, and aimed at helping patients with their ongoing management of their condition. The other is a consultant-led clinic run by Mr Alfred Addison who will see patients needing more expert clinical input such as a review of any change in their cancer status, or who need more exploratory work or follow-up procedures.
The two clinics look after between eight and 10 patients. Cristina has five slots in her clinics with two of the slots taken up with new referrals and three patients with ongoing maintenance. When she has two new patients, she will focus on pre-surgery preparation and ensuring the patient is psychologically ready. She also helps them prepare physically for their procedure. She will inform them of what to expect immediately after the operation. For the three existing patients Cristina will support them and also carry out ‘Moving Forward’ sessions with them.
Moving Forward sessions focus on helping the patient become more proactive with their ongoing cancer care; learning how to check for changes and making sure they contact the hospital immediately if they have any concerns about their recovery or wellbeing and supports them in planning their lives for the future after cancer.
Patients come from a wide area and are referred to the team from The Queen Elizabeth Hospital King’s Lynn and the James Paget University Hospital as well as from the Ipswich and Colchester area. Having been given the opportunity to take clinic space in the new Macmillan Centre in Cromer, patients living in North Norfolk no longer have to travel to the N&N for follow-up clinics, making clinics more accessible. Waiting times in clinics are shorter because they involve fewer patients and the Cromer clinics free up valuable space at the main hospital site where follow-up clinics also take place.
Cristina said: “I will look at pain relief, wound dressings, write to their GP and if I’m taking Moving Forward clinics for my more established patients, I will be looking at helping them have a much more proactive approach to their ongoing care. This involves advising them on how to check themselves and how to spot any changes and to inform us straight away. This means we have a much better chance of helping patients sooner. It also means they can be more independent and manage their own maintenance so they can return to as normal a life as possible.”
She added: “We noticed some of our patients, particularly the older ones, were not telling us about any issues until they were coming in for follow-up appointments, however that might be two months after their initial symptoms or changes, so that could be two months of a missed opportunity to set their mind at ease or to go about addressing the issue at hand.”
If necessary Cristina will refer her patients to Mr Addison’s clinic for immediate review rather than having to make a fresh appointment if there is a clinical issue which needs addressing.
A large part of the Moving Forward sessions is to help the patients psychologically as their wellbeing is of particular importance. Treatment and follow-up support can be quite intensive and when this is removed, it can have a negative effect.
Erica said: “Head and neck cancers have such a huge impact on our patients. They need a high level of support because these cancers are very visible. You might have had part of your jaw removed; you might speak differently, be unable to speak or have a feeding tube. You may have had your whole nose removed or require a tracheostomy tube to breathe through.”
Cristina added: “Quite a few times we can’t predict the outcome of how our communications on eating and drinking is affected. To learn that you will never be able to have a Sunday roast again as you will be fed totally through a feeding tube, this is all part of the Moving Forward sessions. We see patients five years down the line, and they are left with massive side effects from their treatment. They often do not realise the extent of the impact as it is not their focus at the time. They don’t take it in, so this is something we concentrate on in the Moving Forward clinics as it helps them move forwards with their lives.”
It is hoped that once the clinics are more established, the nurse specialists will undertake training to be able to carry out some clinical procedures such as nasal endoscopies which will also speed up patients’ ongoing care issues. There are also plans for nurse-led clinics to be implemented at the Norfolk and Norwich which does not currently have a dedicated Head and Neck department. The learning in Cromer will be used to inform best practice at the N&N when setting up new clinics.
Erica said: “It has been invaluable to us to have these clinics in Cromer and we hope to develop these clinics at the N&N. It is hugely rewarding for us and extremely reassuring for our patients.”
Image: Erica Everitt and Cristina Fernandes. Credit: NNUH