Upload
others
View
3
Download
0
Embed Size (px)
Citation preview
Living with cancer – how to support patients through treatment and after-An oncologists perspective
Dr Kiruthikah Thillai
Consultant Medical Oncologist
Guy’s and St Thomas’ NHS Trust
Mind and Body Lead for the Guy’s Cancer Academy
5 year survival
All Cancers Excluding Non-Melanoma Skin Cancer (C00-C97 Excl. C44): 2010-2011Age-Standardised Five-Year Net Survival, England and Wales
Different cancers- different outcomes
• Metastatic melanoma – 10 years ago – 5 year survival was around 5%
•One in Two Patients With Metastatic Melanoma Alive After 5 Years
– ESMO Sept 2019
– Newer treatments-different side effects
– Ongoing – maintenance treatments
– So varied – personal treatments
– Are we keeping up with the advances in advances in treatments?
Case Study Ms SF
• 41 year old
• Ex smoker, moderate amounts of ETOH
• 3 month history of
• Weight loss
• Loss of appetite
• Low mood
Ms S.F.
Saw GP 4 times over 3 months
Discussed mood -diagnosed with depression
Started on citalopram
No change in symptoms
Declined counselling
Stopped citalopram
DNAd several appointments
6
Diagnosis
Admitted to hospital with painless jaundice
Told her diagnosis whilst alone on the acute medical post take round
Dr Google – 5 year survival for stage 4 pancreatic cancer (3%)
7
Pancreatic Cancer (C25): 2010-2011Net Survival up to Ten Years after Diagnosis, Adults (Aged 15-99), England and Wales
Please include the citation provided in our Frequently Asked Questions when reproducing this chart: http://info.cancerresearchuk.org/cancerstats/faqs/#HowPrepared by Cancer Research UKOriginal data sources:Survival estimates were provided on request by the Cancer Research UK Cancer Survival Group at the London School of Hygiene and Tropical Medicine. http://www.lshtm.ac.uk/eph/ncde/cancersurvival/
Case Study Ms. SF
• Seen in clinic
• Told incurable pancreatic cancer
• Overall survival around 11 months
Palliative chemotherapy
• FOLFIRINOX• Standard chemotherapy
• 3 drug combination
• PICC line – visual daily reminder
Consented
On chemotherapy, good response on imaging
• 3 months of chemo – good response-continued to an ‘on treat clinic’
• Seen every 2 weeks – no opportunity to discuss how she actually was ( no CNS in this clinic)
– QOL data
– PRODIGE study –
• Improved QOL based on EORTC QLQ-C30 scales that are usually most affected in patients with
pancreatic cancer (global health status [GHS], fatigue, pain, physical functioning (PF), emotional
functioning, and role functioning)
What mattered to her?
• Death
• Fatigue-not being able to enjoy the time she has left
• Ongoing low mood*
• Amount of time spent in hospitals
• PICC line
• Hair loss
• Body image
• Fertility
• Sex
• Dating
*Super complicated!
Pancreatic cancer and
depression –strong links – more
research needed
What can we do?
• EDUCATION!!!
• Much more multi-professional learning
• Much more tailored care for patients (more patient focused!)
– Different ages
– Different genders
– Different ethnic groups
– Different socio-economic groups
Guy’s Cancer Academy
• Educational branch of Guy’s Hospital and Guy’s Cancer centre
• Funded by Guy’s Cancer Charity
• Focuses on multi-professional education
• Patient focused – all projects include patients as co-researchers/Co-designers
• Different work streams
– Mind and Body
The link between Mind and Body
Design educational resources for staff and patients that will
cover
• The psychological needs of patients with
cancer
• Understand holistic care
• Address our diverse patient population and the
different needs of our patients
• Promote well being in our staff
Mental health and cancer
• Anxiety – occurs in 20 % of patients with cancer
• Depression – occurs in 10% of patients with cancer
• This is regardless of
– Cancer trajectory
– Palliative vs curative treatment
– Not just reactive!!
Patient-
centred
projects
In-DEPTH (holistic
needs
assessments)
Communication
skills
Sex/Relationships/
FertilityPromoting
diversity
Develop online
resources for
patients
Mental health and cancer
• Current – oncologists identify patients with needs – refer to psychology/psychiatric services
• NEW
– Patients fill in validated questionnaires
– Refer to services appropriately
– Highlight individuals needs
– Educate multi-professional staff
Pancreatic cancer and depression
• Retrospective studies looking at mental health records and correlate with
pancreatic cancer diagnoses
• Prospective work in oncology clinic – screening tools for depression
• Monitor depressive symptoms – correlate to outcomes and treatment responses
Innovative co-Design and Evaluation of care Plan Training and education for Holistic needs (InDEPTH)
• Improve the use of Health Needs Assessments (HNAs)
• Develop and deliver training to support completion of person-centred,
individualised, HNAs and care plans
• Standardise completion of HNA care plans to address inequalities in
experience and outcomes for people following a cancer diagnosis
• Develop online resources
Diversity
• Understanding the diverse population that we serve in GSTT
• Recognising that different patients have different experiences
• Age/Gender/Ethnicity
• Focus groups – address patients needs
• Individually-tailored cancer care
Developing understanding about the impact of cancer on body image, sex and relationships 4/2/20
• Important we understand the effects that cancer and treatment has
on body image
• Effects on fertility – newer treatments with different side effects
• Need to talk more about sex! (and relationships)
• One-day event for patients and staff – discussing patient
experiences and seminars from experts
Tackling staff ‘burnout’
• Increasing pressures on our staff
• Often managing challenging situations
• Important to promote well-being amongst staff
• Psychologist-led group sessions for junior doctors – reflection
• Developing education and training for administrative and clerical staff
• Supporting our teams
To summarise
• Educate staff about holistic approach to treating cancer
• Focus on mental health
• Shameless promotion of ‘Sex, fertility and relationship’ day!!
Thanks to Guy’s and St.Thomas’ Charity for funding
Guy’s Cancer Academy for the first 3 years.
Email [email protected],uk
Twitter – @KiruthikahT