Download Survivorship in breast cancer

Survivorship after Breast
Cancer
Michelle Derbyshire
Macmillan Breast Care Nurse
Sunderland Royal Hospital
February 2012
What is Survivorship
 A patient that has completed their initial
cancer treatment and has no apparent
evidence of disease.
UK Survivorship Statistics
 2 million cancer survivors in the UK at the end
of 2008
 28% of survivors are recovering from breast
cancer
 30-50% of the cancer survivor population will
require some form of intervention to enable
them to effectively manage the
consequences of treatment. (Macmillan
2008)
Survivorship in Sunderland
 Pockets of good practice everywhere
 Share the work we have undertaken in
Sunderland
 Developing and End of Treatment Workshop
 Started the programme in 2008
 Now well established but constantly
changing!
Historical Practice
 Breast Care Nurse supported patients
throughout their cancer journey but
terminated contact at the end of adjuvant
therapies
 Expectation for patients to self refer for
prosthetic fitting, extra support or symptom
management.
Drivers for Change
 Through intuition and qualitative data it
became evident that many women were
struggling following treatment for breast
cancer
 Feelings of abandonment
 Isolation
 Fear of the future / recurrence
 Increased referrals to GP’s health
professionals for support and symptom
advice
Government Reform
 Cancer Reform Strategy (2007)
 Macmillan Cancer Support
 Charitable Bodies
 Breast Cancer Care
 Patient Led
Catalyst for change
 Found that people with cancer often feel
abandoned during the first year of completing
their treatment
 Growing evidence that post primary treatment
support group programmes can increase
quality of life and psychological functioning
End of Treatment Workshop
 Helping to give women with breast cancer the
skills and tools to manage their own care
without the aid of a “key worker”
 Face the future with a positive attitude
 Sign post to available support
 Enhance knowledge and enable patients to
seek medical advice when appropriate
 Use of the holistic needs assessment to help
shape the sessions
Areas discussed
 Follow up
 Side effects of Endocrine therapy
 Lymphoedema
 Nutrition
 Exercise
 Body image/ sexuality/relationships
 Prosthesis/reconstruction
Contd..
 Returning to work
 Holidays
 Dispelling the myths
 Symptoms to look out for
 Who to contact
 Ongoing support
Statistics
 A review of sessions July 08 –January 2012
 27 sessions performed
 283 patients attended
 Of those invited 60% have attended
Contd..
 40% did not attend
 50-70% of cancer survivors will not
experience psychological distress following
surgery
 (DoH 2008 survivorship initiative think tank)
 Therefore we hope we have captured the
patients requiring support in our service
Demographics
 35% of patients in our group were aged 70+
 When asked the reason for not attending the
workshop patients quoted the following
reasons: Not relevant, more for the younger patients
 Private person didn’t like group sessions
 I’ve already relied too much on my family to
bring me to hospital appointments for
treatment
Continuing to improve the Patient
experience
 Identifying how women adjust to getting back
to normality 1 year post adjuvant treatment by
inviting ladies to a “ moving on after breast
cancer session” facilitated by the breast care
nurses with a bigger emphasis on what is
available within the community setting
 smoking cessation/ health trainers/ diet
exercise/ counselling service/support groups
Drop in session
 Once a month in the hospital setting
 Facilitated by the breast care nurses
 Mainly directed towards patients currently
receiving chemo or herceptin for primary
breast cancer however there is a cohort of
patients that continue to attend over a year
on and offer support to the new patients
coming along
The Future
 Many breast cancer patients are now “ living
with their cancer “ for many years due to
improved treatments.
 So our aim is to role this out to metastatic
patients and to tailor make it to their needs.
Conclusion
 It is not easy changing a service
 Its about adapting to new ways of working
 Better time management
 It definitely benefits patients
 Less patient referrals for symptom control
 Allows the patient to take control
 Thank you for your time
 Any questions??