Back to the Floor - Chemotherapy

I go back to the floor twice a month to find out what it’s like for our patients to be treated here, what it’s like for our staff to work here and to see if there is anything I can do to make it better place for both patients and staff. Our hospitals are enormous places and not all of our staff knows what happens in different departments so part of my blog is also aimed at making it a bit easier to understand for our staff, our governors, our volunteers and anyone else who reads it! I hope my blog gives you a tiny flavour of the fabulousness that I saw!
  
The Rosemere Cancer Centre opened in February 1997 with the new chemotherapy daycase facilities opening in 2012. During this time the unit has continued to grow the numbers of patients that are treated there and the breadth and complexity of the treatments that are provided on site. The unit provides treatment for local cancer patients from Preston, Chorley and South Ribble as well as the wider population of Lancashire and South Cumbria with more complex treatments, concurrent chemotherapy and radiotherapy and treatments that form part of clinical trials. Chemotherapy can vary widely and can be given in tablet form or by injection just under the skin (subcutaneous) but the majority are given into the vein. Developments have meant that because sub-cutaneous and oral options have expanded in recent years many more people can have their care at home.
The length of time it takes to administer chemotherapy as an outpatient ranges from 30 minutes to 9hours 30 minutes and all of these can be delivered on the Day Case Unit which is open Monday-Friday from 8am to 7pm. The unit has 16 treatment chairs and 2 side rooms but does flex and increase the number of chairs when necessary to meet demand.

Chemotherapy Daycase Staff

The team have been very proactive in looking at ways to improve the service. They spent an evening with the acute oncology team and other colleagues from the ward and pharmacy to review the workflow and look at ways of improving the service.  They have introduced nurse-led oral chemotherapy clinics and are following up ideas from the service review evening for other specialist clinics which would help make it better for all our patients. In the near future, they are looking to extend the working hours to reflect the increased workload and provide more options for patients.

 
Around 40 new chemotherapy booking referrals are received each week and this covers a wide range of treatments. Of the 40 new referrals approximately 25 are new patients who are having chemotherapy for the first time and around 15 are patients who are changing treatment. This works out at around 5 patients attending the unit for the first time every day. Overall the unit treats between 50 and 80 patients each day depending on the complexity of the treatments.
 
I had the opportunity to spend a lot of time with our patients.  They ranged in age from very early twenties to late eighties, some patients were accompanied and others were alone, all had very different experiences and expectations. Without exception they praised every member of staff from the domestics, porters, ward clerks and nurses to the doctors, volunteers, consultants, switchboard operators and parking attendants.  I feel unbelievably proud of our staff – when we get it right, we really get it right!  

 Chemotherapy Daycase StaffLeft to right: Laura Hall, Tara Kettle, Gwen Tunstall, Karen Sanderson, Lorraine Cahoon, Sara Mohun, Emma Hardman, Libby Westhoff-Lewis, Lisa Nicholson, Rebecca Biltcliffe.

 The team on the unit also work closely with members of the acute oncology team who cover the helpline, which is based on the unit and often share the clinical space to assess patients contacting the helpline as an emergency, they also carry out treatment pre-assessments and insert PICC lines. When I did my Back to the Floor in Interventional Radiology I saw a PICC line being inserted …but you’ll have to wait for me to write that blog to find out what I saw!One of the things I hadn’t appreciated was the financial hardship for so many of our patients. Several told me that being self-employed and unable to work during rounds of treatment had put a huge strain on themselves and their families at a time when their focus should have been on getting through it all. Macmillan has done some research about the scale of the financial burden of loss of income and the additional cost faced by people living with cancer. Did you know that on average four out of five cancer patients lose £570 a month, one in three lose £860 a month either because they can’t work or have to reduce their hours and six out of every seven diagnosed with cancer increase their monthly expenses by £270 a month. Life is hard enough with cancer without the extra strain of worrying about money.

The staff on the unit have a great sense of fun and humour as did many of the patients, plenty of banter and jokes flying around. There was a great sense of practical can-do, solve-anything, no-problem-too-big-to-be-tackled attitude from everyone I met. It’s a place where no subject is off-limits and space and time is found for all. This team pull together as one and just towards the end of my shift a very poorly patient was brought in by ambulance; their only desire was not to die in hospital. Community, social care and hospital staff pulled out every stop to get this patient where they wanted to be and we heard later that day that this last wish was fulfilled and they died in their chosen place. I am so grateful to everyone that we could honour this last request.
 
A personal bit ………..
 
Last year my mum was diagnosed with Stage 3 oesophageal cancer and had several courses of chemo-radiotherapy that finally finished in January 2015. She had most of her treatment in Manchester but she also had some diagnostics at Royal Preston. From everywhere and everyone she was treated with incredible kindness, as her family we were treated with incredible respect, inclusion and care. We have experienced all that is good in the NHS and made to feel like family by the people who have cared for her and us. She’s doing well at the young age of 77 and is back to doing all the things she used to – which mostly involves driving me and my 2 sisters daft. We wouldn’t have it any other way! Thank you to everyone in the NHS who helped to keep her with us to see her eldest grandchild start university, see her youngest grandchild get his first car and see our youngest sister get married. We hope there will be lots more firsts to come.
 
So an enormous thanks from me to all the staff and volunteers on the unit. You make a difference to patients’ lives, to those of their families and friends and thousands of people you’ll never meet.