Thursday 20th June 2013
Helen Fieldson, Macmillan Occupational Therapy Project Lead, describes progress on a two-year project that is developing and delivering occupational therapy to oncology and haematology outpatient clinics at Lincoln County Hospital.
As a Macmillan Occupational Therapist, I enable ‘people to achieve health, well-being and life satisfaction through participation in occupation’.1 Patients and carers experience major changes in their lives whilst undergoing cancer treatment. Some patients are admitted to hospital because they cannot cope with the daily challenges that treatment regimes bring.
During my 15 years’ oncology inpatient experience, many patients have described problems that could clearly have been predicted and prevented, or at least lessened, if they had been seen earlier on in their pathway. Radiotherapy and chemotherapy can be emotionally and physically demanding, involving time off work, juggling home life, dependency on friends and family, long commutes and waiting around for hours in clinics. Combined with other risk factors such as co-morbidities, frailty or lack of support, these can affect symptom control, tolerance of continuing treatment and future health and social care needs.
With this in mind, I submitted a case of need for two years of Macmillan funding for an OT project manager and assistant post, to develop and pilot a service to oncology and haematology outpatient clinics.
The application was successful and the project commenced in April 2012, and is due to be evaluated by March 2014.
Its main aims are to:
- help reduce the impact that cancer can have on the physical, functional, social and emotional wellbeing of patients and their families
- support approaches that help prevent avoidable admissions and reduce the length of inpatient stays.2,3
Patients are referred by oncologists, radiographers, chemotherapy nurses and cancer nurse specialists. The patient is contacted by phone to agree an appointment time, normally on the same day as their treatment or clinic appointment.
Outcomes so far
The service focuses on early interventions using enhanced recovery principles, self-management and fatigue-management tools, health promotion, exercise scheme referrals, and fostering activities and behaviours that encourage well-being. These have already contributed to the project’s positive outcomes, which include:
- avoiding complications and admissions
- supporting reduction in the length of inpatient stay
- positive feedback from patients and families
- integrated care with community and inpatient colleagues
- appropriate referrals to community services
- seamless support.
Timely intervention for Brian
Brian was receiving radical treatment for prostate cancer. He was referred to me by a radiographer. ‘Without doubt, the diagnosis of my prostate cancer was an unexpected and unwelcome intrusion in my life,’ Brian says.
‘In my case, with my congenital disability of the legs, the effects of the treatment were exacerbated and caused more distress than I could have anticipated. My ability to cope with the side effects of the radiotherapy, my independence and my confidence very quickly disappeared and I became quite depressed.’
Brian and I identified priorities for his daily activities, including roles, responsibilities and relationships, looking at his strengths and problems. We explored the impact of his changing physical and emotional needs, his home environment, radiotherapy routines and the side effects of treatment on his wellbeing.
Together, we identified strategies to help him manage these challenges, which in turn helped him deal more effectively with a necessary inpatient stay, resulting in a timely discharge home. ‘There is no doubt,’ Brian adds, ‘that Helen’s timely intervention in my life during the time I was suffering the lows of cancer treatment provided the much-needed emotional and practical help, as well as the friendship I needed to become, once again, more positive about my future.’
Brian's illness, life’s narrative, social situation, relationships, hopes and interests all played a significant part in how he responded to his problems.
Yet, sadly, despite the growing literature and policy supporting a holistic view of cancer treatment, the prevailing culture in secondary care is still the medical model.4 The hope is that this project will support the development of a truly holistic, rehabilitative and multidisciplinary team approach towards achieving the best outcomes for patients undergoing active treatment.5
Email Helen Fieldson, BSc (Hons) Adult Cancer Care, Macmillan Occupational Therapy Project Lead, United Lincolnshire Hospitals NHS Trust.
1. British Association of Occupational Therapists and College of Occupational Therapists. Definitions and Core Skills for Occupational Therapy. 2009.
2. Department of Health. Improving Outcomes: A strategy for Cancer. 2011.
3. NHS improvement. Fulfilling the Potential: A Better Journey for Patients and a Better Deal for the NHS [PDF, 1.44 Mb]. 2012.
4. Macmillan Cancer Support. Allied Health Professionals in Cancer Care: An Evidence Review [PDF]. 2010.
5. NHS East Midlands Cancer Network. Delivering the Supportive and Palliative Care Improving Outcomes Guidance Across East Midlands: Priority 8 – Rehabilitation Service [PDF] . 2010.