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Last year, my colleague Clare Churcher, Gynae Oncology CNS and I piloted a nurse-led survivorship clinic for women with ovarian cancer at the Velindre Cancer Centre| in Cardiff.
Gynaecological referrals to the centre have increased over the last five years and are expected to continue increasing. Based on this, and the fact that women with ovarian cancer are living longer, we felt it was necessary to deliver alternative follow-up care. Women being cared for at the centre also felt they couldn't take up their consultant's time with survivorship issues.
Having previously run a nurse-led chemotherapy clinic alongside doctors, we believed we could apply a similar model, and that the nurse-led and consultant-led services would complement each other.
We set up the survivorship clinic to discuss individual health needs and any associated problems. Common survivorship issues for ovarian cancer include psychosexual problems, altered body image and fertility issues. Some younger women experience post-menopausal symptoms following their treatment and say they do not feel feminine anymore. They can be tearful, have mood swings and loss of libido.
Our first clinic ran for three hours, with a 20 minutes slot for each patient. It became clear that 20 minutes was not enough, as each person took 30–45 minutes to discuss their concerns in detail. We now allocate 30 minutes, which is adequate for most women, but we are looking to review this. We also offer telephone follow-up.
Many of the women attending the first clinic had issues such as weight gain, exercise and diet, and concerns about finances and employment rights. We discussed a variety of coping mechanisms.
For many, it is about learning to live with their diagnosis and trying to live a ‘normal’ life again. Women attending the clinic may have had intensive treatment, involving visits to the centre for clinic appointments and chemotherapy for 18 weeks or longer. To then be faced with being told, ‘we’ll see you in two to three months’ can be very daunting.
For some, facing life again without having the security of appointments at the centre is very frightening. Clare and I often find our patients need a lot of support following completion of their treatment. It’s all about adapting and tailoring the service to the individual.
A patient satisfaction questionnaire was sent out to 30 women in February and 25 forms were returned. Responses showed that patients were very satisfied with the clinics. We also started a monthly psychosexual treatment clinic for women with gynaecological cancers and some people living with colorectal cancers last September. We are looking to audit it soon.
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