Survivorship after Breast Cancer

Michelle DerbyshireMacmillan Breast Care Nurse

Sunderland Royal HospitalFebruary 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??