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Allied Health Professional (AHP) Cancer Rehabilitation Directory of Services Produced by AHP Lead and AHP Group for North of England Cancer Network Date: March2012 Review: September 2013 Updated: January 2014 NECN Cancer Rehabilitation Specialist AHP Services Directory January 2014 1 Contents Introduction ........................................................................................................................................ 3 What are Allied Health Professionals? ............................................................................................. 3 Cancer Rehabilitation Care Pathways .............................................................................................. 4 Referral to Generic Allied Health Professional (AHP) Services ..................................................... 6 Roles and Referral Criteria for Specialist AHP Services ................................................................ 6 Dietitian............................................................................................................................................. 6 Occupational Therapy....................................................................................................................... 7 Physiotherapy ................................................................................................................................... 8 Speech and Language Therapy ....................................................................................................... 8 Contact Details ..................................................................................................................................11 Patient Information Leaflet ...............................................................................................................18 References .........................................................................................................................................21 NECN Cancer Rehabilitation Specialist AHP Services Directory January 2014 2 Introduction The Aim of this directory is to provide information that can support professionals and patients through their journey. The directory provides information on the roles of Allied Health Professionals and what they can do to help patients with their Rehabilitation and Supportive Care needs. Rehabilitation for people with cancer aims to help make the most of what they can do. The aim is to promote independence and help people adapt to their condition. A cancer diagnosis, treatment and side effects can influence what patients can do and how they feel. Patients may benefit from rehabilitation at the time of diagnosis and throughout their treatment and care. Patients’ rehabilitation and care needs should be checked at key points along the patient pathway. What are Allied Health Professionals? Allied Health Professionals include Chiropodists, Dietitians, Occupational Therapists, Orthotists, Physiotherapists, Prosthetists, Psychotherapists, Psychologists, Radiographers, Speech and Language Therapists and Lymphoedema Therapists. This directory focuses on information about the following AHP’s: Dietitians Occupational Therapists Physiotherapists Speech and Language Therapists The role of the specialist AHP is to maximise a patient’s function, improve their level of independence, assist with activities of daily living, assess and provide appropriate equipment to enable this and provide strategies for coping mechanisms for both the patient and their carer/family. This process should be throughout their cancer pathway. It is not the responsibility of one sole group of AHPs to provide this specialist rehabilitation; it is a combination of the AHP specialist skills that are required. NECN Cancer Rehabilitation Specialist AHP Services Directory January 2014 3 Cancer Rehabilitation Care Pathways The National Cancer Action Team has worked with Allied Health Professionals since 2007 to develop evidence based cancer rehabilitation care pathways for 9 cancer specific sites and 11 symptom care pathways. In 2010 the national care pathways were published for:- Brain and CNS Breast Colorectal Gynaecology Head & Neck Lung Upper GI – Hepatobiliary pancreas Upper GI – Oesophago gastric Urology Each cancer rehabilitation care pathway is split into broad areas of:- Pre-diagnosis Diagnosis & care planning Treatment Post Treatment Monitoring & Survivorship Palliative Care End of Life At each stage of the pathway the likely intervention of the AHP is defined. The care pathways recommend the interventions be carried out by specialist AHPs (see Roles and Referral Criteria for Specialist AHPs). Each cancer site specific care pathway highlights common symptoms experienced by these patients that would benefit from Specialist AHP assessment and intervention e.g. Lung cancer patients may experience symptoms of pain, fatigue, breathlessness, communication difficulties, anorexia/ cachexia and dysphagia and who would benefit from input by a specialist AHP. The cancer rehabilitation care pathways will provide further information on assessment and interventions by each Specialist AHP and help to determine a referral to the relevant AHP service or services. The flowchart on the next page shows the indications for referral to AHP’s (page 5). CANCER REHABILITATION CARE PATHWAYS Treatment Diagnosis Post Monitoring Palliative & care & Allied Indications for Referral to NECN Cancer Rehabilitation Specialist AHP Services Directory January 2014 Care planning Treatment Survivorship Health Professionals (AHPs) End of Life 4 Cancer patients are at risk of developing or experiencing the symptoms detailed below. Cancer Rehabilitation needs should be assessed* at all stages in the cancer care pathway *Holistic Needs Assessment Tool e.g. Distress Thermometer, SPARC, PEPSICOLA should be used to ascertain patients concerns & identify rehabilitation needs. Ensure the patient has information on cancer rehabilitation and role of AHPs When a rehabilitation need is identified - consider the level of intervention required: Is the symptom of little concern or already self adapted? YES NO Encourage self management & offer supportive written information Is the symptom impacting on function or quality of life? NO YES Is the symptom likely to impact treatment options or become more debilitating over time? YES NO Refer to Specialist Cancer AHP services who can offer expert advice, an integrated care plan and ongoing support for future potential problems Refer to symptom care pathway & consider referral to generic AHP services for assessment and advice To make a referral to an AHP: Please see your Local Cancer Rehabilitation Service Directory (available on your Cancer Network Website) DIETETICS Eating problems due to changes in appetite, anorexia, anxiety, fatigue/tiredness, taste changes, nausea and vomiting, dysphagia, ulcerated mouth, mucositis, constipation, diarrhoea, stoma outputs, indigestion or pain High nutrition risk score / Unintentional weight loss / Low BMI (<18.5) / Cachexia / Malnutrition Already having or considering artificial feeding Complex dietary needs secondary to co morbidities e.g. Diabetes, Crohn’s Disease, Coeliac Disease, food intolerances or following alternative / exclusion diets or taking large doses of vitamins, minerals or herbal supplements Obesity (BMI >30) / weight gain - NB only in the monitoring and survivorship stage of pathway OCCUPATIONAL THERAPY Inability to undertake activities of daily living, leisure & work resulting in loss of independence due to cognitive / perceptual impairment, sensory impairment, reduced mobility or reduced use of upper / lower limbs Anxiety due to diagnosis & treatment, changes in function, role, body image, sexuality Fatigue / tiredness Environmental adaptations / equipment needs Moving and handling problems Seating and positioning LYMPHOEDEMA THERAPY Oedema / swelling of one or more limbs and may include the corresponding quadrant of the trunk. Swelling may also affect other areas, e.g. head, neck, breast, genitals PHYSIOTHERAPY Respiratory problems e.g. breathlessness, cough or difficulty expectorating secretions Fatigue Mobility / functional problems/loss of independence due to weakness, stiffness and contractures, swelling, pain, impaired balance, sensory impairment, other neurological symptoms Reduced exercise tolerance / stamina due to fatigue, exhaustion, tiredness Anxiety causing tension or hyperventilation Mobility equipment needs Moving and handling problems Pain management SPEECH & LANGUAGE THERAPY Communication difficulties resulting from speech problems, expressive and receptive language difficulties and voice changes Dysphagia (difficulties swallowing) symptoms may include food sticking, coughing, choking or wet / gurgly voice when eating / drinking Laryngectomy voice rehabilitation including voice prostheses management, oesophageal voice or electrolarynx use NECN Cancer Rehabilitation Specialist AHP Services Directory January 2014 5 Referral to Generic Allied Health Professional (AHP) Services A holistic needs assessment should be carried out by the patient’s key worker (nurse specialist, district nurse, GP etc). This assessment should identify any rehabilitation and supportive care needs which may require referral to an Allied Health Professional. All patients should be able to access generic AHP services in their area. However, some patients require assessment and intervention by more specialist AHP’s. The cancer rehabilitation care pathways should help to indicate the level of rehabilitation intervention required and if a referral should be made to a specialist AHP service. The generic AHP service should be able to help direct the referral to the most relevant generic or specialist AHP. (See flowchart for pathway of assessment and referral to AHPs, page 5). Roles and Referral Criteria for Specialist AHP Services The directory provides a list of organisations that provide specialist AHP services (see below). Specialist AHPs work mostly or exclusively with patients who have cancer and who provide expert advice and input for clearly defined rehabilitation needs. This section explains the roles of the specialist AHPs and an indication of their referral criteria. Please note that their may be local variation and you should always clarify this with the service you would like to refer to. Dietitian The role of the Dietitian is to provide dietary advice and support when needed. This may be at diagnosis, during treatment and ongoing monitoring as required. Patients who are particularly at risk of nutritional problems are those about to commence intensive treatment, chemotherapy, radiotherapy or surgery. Patients may be referred to a Dietitian if they have lost weight or have a poor appetite. Patients may have other symptoms that make eating and drinking difficult. Patients and their carers may be uncertain about what is best for them to eat. The Dietitian will carry out an assessment to identify possible problems. Dietary advice and support will be given to meet the patients’ individual needs. This may be to help patients improve or maintain their weight, improve their food intake or advice to help cope with eating problems. NECN Cancer Rehabilitation Specialist AHP Services Directory January 2014 6 Below is an example of referral criteria to the specialist dietitian. Patients who have lost 10% of body weight and have one or more of the following symptoms:- Nausea/Vomiting Altered bowel - diarrhoea, constipation, malabsorption. Signs of dysphagia or swallowing problems - dental, pain. Taste changes Dry mouth Stomatitis or mucositis Anorexia Anxieties affecting food intake Example referral criteria: Patients who are in hospital or discharged home receiving, or being considered for, artificial nutrition. Patients who have complex dietary needs secondary to co-morbidities e.g. diabetes, Crohn’s Disease, Coeliac Disease, food intolerances or following alternative/ exclusion diets or taking large doses of vitamins, minerals or herbal supplements. Occupational Therapy The role of the Occupational Therapist is to help maintain the optimum level of independence for the patient. Patients who may benefit from referral to the Occupational Therapist are those who have problems with tiredness/ fatigue, managing daily activities (such as washing, dressing and personal care), physical functioning, pain, breathlessness, changes in cognitive function and psychological aspects. The Occupational Therapist will work with the patient finding out which activities are important to them and suggest ways to help overcome difficulties such as:- finding new or different ways to do things, planning a rehabilitation programme, advising on equipment or adapting the environment to help with independence finding ways to cope with problematic symptoms which can impact on daily living. NECN Cancer Rehabilitation Specialist AHP Services Directory January 2014 7 Example referral criteria: Any patient who experiences changes in their ability to carry out daily tasks. Physiotherapy The role of the physiotherapist is to try and help reduce some of the effects of the patient’s illness. The aim is to improve the patient’s quality of life, maintain or prevent problems and help with managing day to day activities. As appropriate, the role and importance of exercise in managing the symptoms of cancer and cancer treatment and in reducing the risk of secondary spread or recurrence of disease would be explained and an intervention plan would be made. Patients may benefit from a referral to a physiotherapist are those who have the following problems:- Mobility/ functional problems/ loss of independence Fatigue Pain management Joint mobility Pre and post surgical Manual handling Oedema/ lymphoedema management Shortness of breath Difficulty expectorating secretions Speech and Language Therapy Speech and Language Therapists will assess, diagnose and provide ongoing management of communication and swallowing difficulties. Such difficulties may be mechanical or neurological in nature. The Speech and Language Therapist may:- Provide assessment and management of communication and swallowing difficulties. Provide information regarding the likely effects of treatment. This will be in relation to communication, eating and drinking. Provide communication and swallowing therapy intervention as appropriate. Give advice regarding the use of communication aids equipment. Advise on food and liquid consistencies. Provide ongoing assessment and advice. NECN Cancer Rehabilitation Specialist AHP Services Directory January 2014 8 Provide advice regarding saliva management. Neuro-oncology client groups may require a referral to Speech and Language Therapy for the following reasons: Pre and post operative assessment due to location of tumour Acquired Dysphasia (language difficulties) Acquired Dysarthria (speech difficulties) Dysphagia (swallowing difficulties) Advice regarding alternative and augmentative communication (AAC) aids Survivorship issues involving communication/ swallowing difficulties Advice regarding strategies for patients/ families/ carers to help improve communication effectiveness NECN Cancer Rehabilitation Specialist AHP Services Directory January 2014 9 Pathway for Assessment and Referral to Generic and Specialist AHP Cancer Rehabilitation & Supportive Care Services Change in condition/ concern raised by health care professional, patient or carer. Holistic Assessment and consideration for rehabilitation/ AHP involvement by key Worker e.g. CNS, GP, District Nurse etc. No rehabilitation/ AHP needs identified. Local intervention, patient Information and Support. Consider exercise treatment intervention Requires referral to AHP for assessment. Consider exercise treatment intervention Referral triaged to relevant AHP (specialist/ generalist) Refer to locally agreed criteria to AHP services (see directory for specialist AHP services) AHP contacts patient/ appointment made. Patient discharged from AHP services and notifies key worker. AHP provides assessment and intervention. Action plan agreed with patient. AHP refers to other agencies as required. NECN Cancer Rehabilitation Specialist AHP Services Directory January 2014 NECN Cancer Rehabilitation Specialist AHP Services Contact Details Locality Organisation NHS - Cumbria Cumbria Partnership Workington NHS Foundation Community Hospital Palliative Care Trust Park Lane Workington CA14 2RW West Cumberland Hospital Hensingham Whitehaven Cumbria CA28 8JG North Cumbria University Hospitals NHS Trust Therapy available service Contact Details Occupational Therapy Physiotherapy 01946 693181 (main hospital switchboard) Dietetics 01946 693181 (main hospital switchboard) Speech & Language Therapy (Brain & CNS/ Palliative Care) Cumberland Infirmary Speech and Language Newtown Road Therapy (Head & neck/ Carlisle CA2 7HY 01900 705200 (west of the county) 01946 693181 (main hospital switchboard) 01228 814730 Brain & CNS/ Palliative Care) Physiotherapy 01228 523444 (main hospital switchboard) NHS - Durham Co. Durham and Darlington NHS Foundation Trust Dietetics 01228 814794 Darlington Memorial Dietetics 01325 743152 Hollyhurst Road, Darlington, County Durham, DL3 6HX (Head and Neck only) (Head and Neck only) booking 01388 825700) Macmillan Community Team, Bishop Auckland Occupational Therapy 01388 607301 Community Palliative Care Team, Peterlee Dietetics 0191 569 2875 Easington Macmillan Services The Centre for Health Traynor Way Physiotherapy 0191 569 2875 Speech and Language 01325 743001 (Central appointment Therapy Covering Richardson Hospital, Barnard Castle; Sedgefield Hospital; Weardale Hospital, Stanhope; Butterwick Hospice, Bishop Auckland NHS County Durham and Darlington Community Health Services 11 Whitehouse Business Park Peterlee Co. Durham SR8 2RT NHS – SoTW (South of Tyne) South Tyneside NHS Foundation Trust South Tyneside District Hospital Harton Lane South Shields NE34 0PL Bensham Hospital Dietetics 0191 404 1084 Occupational Therapy 0191 404 1000 Occupational Therapy 0191 445 5226 Occupational Therapy 0191 451 6396 Saltwell Road Gateshead NE8 4YL South Tyneside Community Palliative Care Team Fax: 0191 451 6364 Admin Building Primrose Hill Hospital Primrose Terrace Jarrow NE32 5HA City Hospitals Sunderland NHS Foundation Trust Sunderland Royal Hospital Physiotherapy 0191 565 6256 Kayll Road Sunderland SR4 7TP Dietetics 0191 569 9013 (Head and Neck) Speech and Language 0191 569 9009 Therapy (Head and Neck, Laryngectomy) Gateshead Health NHS Foundation Trust Queen Elizabeth Hospital Dietetics 0191 445 2074 Sheriff Hill Gateshead NE9 6SX Occupational Therapy 0191 445 5226 Physiotherapy 0191 445 2665 (Breast & gynaeoncology) Lymphoedema 0191 482 0000 (Breast & gynaeoncology) 12 NHS – NoT (North of Tyne) Northumbria Healthcare NHS Foundation Trust Community Macmillan Physiotherapy Teams North Northumberland 01665 626713 Macmillan Office Bondgate Surgery Infirmary Drive Alnwick NE66 2NL West Northumberland 01434 612932 Macmillan Team West Sector Office Dene Park House Dene Park Hexham, NE46 1HN Central Northumberland 01670 857635 Macmillan Office Seaton Park Medical Group Norham Road Ashington NE63 0NG North Tyneside General Hospital Physiotherapy 0191 293 4064 (Breast) Rake Lane North Shields NE29 8NH Lymphoedema 0191 293 4183 (Breast) Sir GB Hunter Memorial Hospital Outpatient Clinics The Green Wallsend NE28 7PB Physiotherapy 0191 220 2210 (Palliative care and Lung) Occupational Therapy 0191 220 5948 13 Newcastle upon Tyne Hospitals NHS Foundation Trust Macmillan AHP’s in Specialist Palliative Care Occupational Therapy & Physiotherapy Freeman Hospital 0191 213 7221/ 0191 213 9488 Freeman Road High Heaton Newcastle upon Tyne NE7 7DN 0191 282 4019/ 0191 282 1880 Royal Victoria Infirmary Queen Victoria Road Newcastle upon Tyne NE1 4LP Northern Centre for Cancer Care Physiotherapy 0191 213 9252 Freeman Hospital Freeman Road High Heaton Newcastle upon Tyne NE7 7DN Occupational Therapy 0191 213 9315 Dietetics 0191 223 1231 Specialist Neurooncology Service Physiotherapy 0191 282 3778 Royal Victoria Infirmary Queen Victoria Road Newcastle upon Tyne NE1 4LP Occupational Therapy 0191 282 3778 Speech and Language 0191 213 7646 Therapy Speech and Language 0191 213 9580 Therapy Neuro-psychology Paediatric Oncology & Haematology AHPs 0191 282 1649 Occupational Therapy 0191 282 1285 & Physiotherapy Great North Children’s Hospital Royal Victoria Infirmary Queen Victoria Road Newcastle upon Tyne NE1 4LP NHS – Tees North Tees & Hartlepool NHS Foundation Trust University Hospital of Hartlepool Specialist Palliative Care Team Occupational Therapy 01429 522154 Fax 01429 406559 14 2nd Floor Hart Building University Hospital of Hartlepool Holdforth Road Hartlepool TS24 9AH Physiotherapy University Hospital of North Tees Dietetics 2nd Floor Farndale House University Hospital of North Tees Stockton on Tees TS19 8PE South Tees Hospitals NHS Foundation Trust James Cook University Hospital Marton Road Middlesborough TS4 3BW 01429 522154 Fax 01429 406559 01642 624768 (Lung only) Physiotherapy 01642 383895 Fax: 01642 383239 Occupational Therapy 01642 383895 Fax: 01642 383239 Dietetics 01642 854777 (Upper G.I, Head and Neck, Gynaeoncology, Palliative Care, General Oncology, Radiotherapy, Chemotherapy) Occupational Therapy 01642 854454 (Oncology and Palliative Care) Rehabilitation centre JCUH Fax: 01642 282607 Physiotherapy 01642 854454 (Upper G.I, Thoracic, Haematology and general oncology) Speech and Language 01642 818544/ Therapy 854039 (Head and Neck, Brain and Fax: 01642 283236 CNS & Palliative Care) Specialist Neurooncology Service Occupational Therapy 01642 850850 Ext. 52210 Physiotherapy Speech and Language 01642 818544 Therapy Harrogate and District Foundation Trust Speech and Language 01723 342237 Therapy (See patients from Whitby/ Saltburn area who have received treatment at JCUH) Scarborough Hospital 15 Woodlands Drive Scarborough YO12 6QL Hambleton and Richmondshire Locality Palliative Care Team Unit 12-14 Omega Business Village Thurston Road Northallerton DL6 2NJ Middlesbrough, Redcar and Cleveland Dietetics 01609 751313 Occupational Therapy 01609 751313 Occupational Therapy 01287 639 100 Fax: 01287 284023 Occupational Therapy 01228 603739 Community Palliative Care Team Guisborough Primary Care Hospital Northgate Guisborough TS14 6HZ NHS – sector Cumbria Voluntary Eden Valley Hospice Durdar Road Carlisle CA2 4SD County Durham Fax: 01228 602743 St Cuthbert’s Hospice Occupational Therapy Park House Road, Merryoaks, Durham. DH1 3QF (Covered by CDDCHS) Lymphoedema 0191 386 1170 Butterwick Hospice Physiotherapy 01388 603003 Willow Burn Hospice Occupational Therapy 01207 529224 Maiden Law Hospital Howden Bank, Lanchester Durham, DH7 0QS Physiotherapy 01207 523290 St Clare’s Hospice Physiotherapy 0191 451 6378 Lymphoedema 0191 451 6378 Physiotherapy 0191 386 1170 0191 386 1170 (Covered by CDDCHS) Bishop Auckland Wood House Lane Bishop Auckland DL14 6JU South of Tyne Primrose Terrace Jarrow 16 Tyne and Wear NE32 5HA St Bede’s Unit Dietetics Queen Elizabeth Hospital Sheriff Hill Gateshead NE9 6SX (cover from Health) 0191 445 2074 Gateshead Occupational Therapy (cover from Health) 0191 445 5226 Gateshead St Benedict’s Hospice Occupational Therapy & Centre for Specialist Palliative Care Physiotherapy 0191 512 8438 0191 512 8442 St Benedict’s Way Ryhope Sunderland SR2 0NY North of Tyne Tees Lymphoedema 0191 512 8400 Marie Curie Hospice Occupational Therapy 0191 2191000 4 Marie Curie Drive Newcastle upon Tyne NE4 6SS Physiotherapy 0191 2191000 St Oswald’s Hospice Occupational Therapy 0191 285 0063 Regent Avenue Gosforth Newcastle upon Tyne NE3 1EE Physiotherapy 0191 285 0063 Lymphoedema 0191 285 0063 Teesside Hospice Dietetics 1 Northgate Rd Linthorpe Middlesborough TS5 5NW Occupational Therapy 01642 811060 ext. 430 01642 811074 Physiotherapy 01642 811074 Butterwick Hospice Physiotherapy 01642 607742 Stockton Middlefield Road Stockton on Tees TS19 8XN (as part of day care services) 17 Your Guide to Cancer Rehabilitation Services Patient Information Leaflet About this leaflet This Information leaflet is about cancer rehabilitation and the roles of Allied Health Professionals. It explains what they can do to help with your Rehabilitation and Supportive Care needs. What is Rehabilitation? Rehabilitation for people with cancer aims to help make the most of what they can do. The aim is to promote independence and help people adapt to their condition. What does this mean for you? A cancer diagnosis, treatment and side effects can influence what you can do and how you feel. You may benefit from rehabilitation at the time of diagnosis and throughout your treatment and care. Your rehabilitation and care needs will be checked at key points. This is called an assessment. What are Rehabilitation Services? There are a number of Allied Health Professionals (AHP’s) who may be involved in providing Rehabilitation Services. These include:- Dietitian Occupational Therapist Physiotherapist Radiographer Speech and Language Therapist Allied Health Professionals (AHP’s) These health professionals may be involved in your assessment, rehabilitation and care. The assessment will take into account your health needs, what you can do and how you feel. They will work with you. With your permission they will also work with people who are close to you and others involved in your care. They will also help you and your carers address the psychological aspects of your condition. Do you have Rehabilitation needs? If you feel that you have rehabilitation needs discuss this with your Key Worker. Your Key worker may be your District Nurse, Clinical Nurse Specialist, GP or consultant. They can refer you to the appropriate Rehabilitation Service as required. Useful Contacts Cancer Backup Freephone Helpline 0808 800 1234 Publications 020 7696 9003 Website: www.cancerbackup.org.uk 18 Physiotherapist The role of the physiotherapist is to try and help reduce some of the effects of your illness. The aim is to improve the quality of your life, maintain or prevent problems and help you manage your day to day activities. You may be referred to a physiotherapist if you have the following problems: Mobility/ functional problems/ loss of independence Fatigue Pain management Joint mobility Before and after surgery Manual handling Oedema/ lymphoedema management Shortness of breath Difficulty expectorating secretions As part of your treatment you may be given exercises, provided with walking aids and given specialist advice. We aim to help improve, maintain or prevent problems, which may occur. Speech and Language Therapist You may be referred to the Speech and Language Therapist if you have problems with your speech, language, voice and / or swallowing. The type of problems that you present with will depend on where your cancer is and how it is treated. The speech and language therapist can: Provide assessment and advice to you and your family or carers at any stage of your treatment. Recommend strategies, exercises, and / or equipment that may help maintain or improve your communication, voice or swallowing Provide advice on the best consistencies to help you eat and drink well and safely Occupational Therapist The role of the Occupational Therapist is to help maintain your best level of independence. You may be referred to the Occupational Therapist if you have problems managing daily activities (such as washing, dressing, meal preparation), have difficulties with tiredness/fatigue, physical functioning, pain, breathlessness, changes in cognitive function and psychological aspects. The Occupational Therapist will work with you to find out which activities are important to you and suggest ways to help overcome difficulties such as: finding new or different ways to do things, planning a rehabilitation programme, advising on equipment or adapting the environment to help with independence finding ways to cope with problematic symptoms which can impact on daily living. Poor appetite Anxieties affecting food intake Radiographer There are two types of radiographers. Diagnostic radiographers are involved in a range of diagnostic tests. They provide advice to people diagnosed with cancer. They are also involved in screening programmes such as the Breast Screening Programme or ultrasound scans and x-rays. In some cases radiotherapy may be the treatment of choice and Therapy Radiographers play a key role in planning and delivering prescribed treatments. They will also give advice on managing possible side effects. This is in addition to giving information and support to you and your family. 19 Dietitian The role of the Dietitian is to provide dietary advice and support when needed. This may be at diagnosis, during treatment and ongoing monitoring as required. You may be referred to a Dietitian if you have lost weight or have a poor appetite. You may have other symptoms that make eating and drinking difficult. You and your carers may be uncertain about what is best for you to eat. The Dietitian will carry out an assessment to identify possible problems. Tailored dietary advice and support will be given to meet your individual needs. This may be to help improve or maintain your weight, improve your food intake or provide advice to help you cope with eating problems. The Dietitian will give advice and support to you and your carers. You may be referred to a Dietitian if you have lost 10% of your body weight and have one or more of the following symptoms: Nausea/Vomiting Altered bowel habits – e.g. diarrhoea, constipation. Swallowing problems - dental, pain. Taste changes Dry mouth Inflammation of the mouth or stomach – e.g. mouth ulcers Poor appetite Anxieties affecting food intake Do you have Rehabilitation needs? If you feel that you have rehabilitation needs discuss this with your Key Worker. Your Key worker may be your District Nurse, Clinical Nurse Specialist, GP or consultant. They can refer you to the appropriate Rehabilitation Service as required. Useful Contacts Cancer Backup Freephone Helpline 0808 800 1234 Publications 020 7696 9003 Website: www.cancerbackup.org.uk Macmillan Cancer Support Freephone 0808 8082020 www.macmillan.org.uk. Carers UK Carersline: 0808 808 7777 Cancer Counselling Trust Tel: 020 7704 1137 www.cctrust.org.uk Marie Curie Cancer Care Tel: 020 7599 7777 www.mariecurie.org.uk Produced by Allied Health Professionals working across the North of England Cancer Network. Date published September 2011 (version v 0.1) Review Date September 2012 20 References National Cancer Action Team – Cancer Rehabilitation http://www.ncat.nhs.uk/our-work/living-with-beyond-cancer/cancerrehabilitation 21
