Friday 15th April 2016
Mac Voice, the magazine for Macmillan professionals: Spring 2016
A Macmillan and TrueNTH partnership is supporting people in Cardiff after pelvic radiotherapy. Helen Ludlow tells Mac Voice about her new nursing post funded by the partnership.
My new nursing post is jointly funded by Macmillan and TrueNTH: a Movember initiative managed by Prostate Cancer UK. The aim of the post is to support people in Cardiff who have developed gastrointestinal (GI) symptoms after having pelvic radiotherapy, including those with gynaecological, colorectal and urological cancers.
The role was developed to support the EAGLE study led by Cardiff University. This stands for improving the wellness of men by Evaluating and Addressing the Gastrointestinal Late Effects of radical treatment for prostate cancer. Support from Macmillan has extended the role to support people who have had any type of pelvic cancer.
Understanding the issues
Up to 90% of people who have had pelvic radiotherapy may go on to develop GI symptoms during or after treatment, and even many years later.  Chronic symptoms can include rectal bleeding, diarrhoea, faecal incontinence and many other problems, which are often embarrassing and debilitating.
Until recently, few patients were referred for gastroenterology input because it was thought little could be done to help resolve these issues. Sometimes people also feel guilty complaining about symptoms caused by treatments thathave cured their cancer. However, guidance produced by a team from the Royal Marsden Hospital, with input from gastroenterologists, has transformed the assessment and treatment of this group of people. The resulting document, The Practical Management of the Gastrointestinal Symptoms of Pelvic Radiation Disease , forms the basis of the new Pelvic Radiation Disease Clinic in Cardiff and Vale University Health Board. Macmillan has also produced a ‘quick guide’ for non-specialists based on the original document and this can be found here.
I undertake an in-depth assessment of each person and request appropriate investigations. Abnormal results are then identified and treatment begins, which can include dietetic intervention (a dietitian is attached to the clinic) or medical therapy. The number of people being seen is increasing by the week as clinicians are becoming more aware of the service.
It is too early to provide much in the way of clinical data, but certainly initial feedback from patients is that it is a huge relief to be able to talk about their symptoms and that hopefully their lives can be improved.
Future plans for the service include setting up a patient support group and improving access to psychological care. We also want to provide education to healthcare professionals involved in the care and follow-up of people who have had radiotherapy for pelvic cancers.
1. Olopade F. et al. The inflammatory bowel disease questionnaire and the Vaizey incontinence questionnaire are useful to identify gastrointestinal toxicity after pelvic radiotherapy. British Journal of Cancer. 2005. 92(9):1663–70.
2. Andreyev HJ et al. Guidance: The practical management of the gastrointestinal symptoms of pelvic radiation disease. Frontline Gastroenterology. 2015. 6(1):53-72.