Thursday 20th June 2013
Rhian Collins, Macmillan Specialist Oncology Dietitian, has been in her post since April 2010 and is based at the Velindre Cancer Centre in Cardiff.
What were your previous roles?
I worked in the University Hospital of Wales as a Band 5 (basic grade) dietitian, for a year and a half. That was a rotational post, gaining experience in different specialties.
Is your present role a new position and how did it come about?
There were two dietitians at Velindre and one dietetic assistant, prior to this role being developed. But the clinical workload was large and two dietitians alone couldn’t cover it. They prioritised head and neck and upper gastrointestinal (UGI) cancers, as these patients require intensive nutrition support. There was a limited service for patients with other cancers including lung, colon and gynaecological, due to a lack of dietetic support. In addition, treatments have changed and services have developed, highlighting the importance of dietetic input. So that’s why this role was developed.
Was there anything specifically in your background that made you suitable?
I’d done some oncology work at the University Hospital of Wales, specifically working with UGI cancer patients who had gone through surgery. Also, a lot of work I did at the University Hospital of Wales was based on nutrition support, which allowed these skills to be transferrable.
What does the job involve?
The other Band 6 (specialist) dietitian and I complete six-monthly rotations. One of those six-month periods is covering the wards, seeing people with all kinds of cancers – lung, colon, gynaecological and some head and neck – a huge range. We provide nutrition support to patients who are receiving or completed treatment, including chemotherapy and/or radiotherapy. I also cover general outpatients during that rotation. The other six months revolve around covering UGI patients only – oesophageal, stomach and pancreatic cancer, primarily. And that role is generally more outpatient-based, as five consultant clinics are covered.
How does the work benefit people with cancer?
Because food is such an important aspect of everyone’s life, and some of the major side effects of chemotherapy and radiotherapy include poor appetite, vomiting, constipation, diarrhoea and weight loss, we provide a range of advice to help people overcome those side effects. This then allows patients to meet their nutritional requirements to continue through and recover from their treatment better.
What projects are you currently working on?
I am the catering lead dietitian for the cancer centre. The main project I’m working on is implementing a new menu for the hospital’s inpatients, which should be in line with All Wales Nutrition and Catering Standards for inpatients. I’m also on the All Wales Menu Group, which is aiming to establish standardised menu options for all hospitals in Wales to use.
What are the greatest challenges of your job?
Trying to help people to be better nourished while experiencing horrible side effects is very difficult. It’s also a challenge trying to adapt our advice to meet individuals’ needs, taking into account the side effects to make sure that we are meeting their nutritional requirements. That’s why we are trained in excellent communication and motivational skills.
How do you deal with the most difficult aspects?
I suppose I try not to think about work outside of it. If you think about it too much, it could make you anxious and low in mood. Also, I see the patients as themselves, more than I see their diagnosis. I think about how I can help them in terms of the point they are at in their treatment.
What are your job’s rewards?
The most rewarding aspect is getting to know your patients, because you really do see them through the thick of their treatment. Also, seeing them at the end, when they’ve been through it and they’re out the other side; when the side effects have eased off a bit, they’re eating better and gaining weight. There’s really nothing nicer to see.
What qualities are most useful in the role?
Empathy is an important quality. Understanding how the patient is feeling and looking at this objectively benefits them greatly. Also, a little bit of the time it’s about having a good sense of humour. As a result, I get on very well with my patients. Furthermore, if someone is given a diagnosis that is either terminal or palliative, you shouldn’t change the way you treat that person. These are important qualities for me in this role.
What projects are coming up?
I’m working with the gynaecological consultants to develop a bowel obstruction pathway. This will be helpful for patients admitted on to the ward with bowel obstruction resulting from a gynaecological cancer, to ensure that their nutritional needs are met. I’m also a member of a group within Velindre that is establishing links with Sierra Leone to improve oncology services there.
Can others learn from your role?
Yes, and we are always, in a way, looking to advertise what we are doing at Velindre, through local and national conferences, posters, talks, articles in journals and discussion. If you’re doing such good work in one place, I think it should definitely be disseminated.