Wednesday 24th June 2015
Mac Voice, the magazine for Macmillan professionals: Summer 2015
Caroline Oates celebrates the impact that two years of Macmillan funding had on dietetic care for children with cancer in Woolwich
I am a Macmillan Dietitian working in a Paediatric Oncology Shared-Care Unit based on Tiger Ward at the Queen Elizabeth Hospital, Woolwich. We are responsible for the ambulatory care of about 60 children receiving active treatment for their cancer, who also attend a Primary Treatment Centre.
As well as managing acute episodes, my emphasis is usually on survivorship. Good nutrition is essential, so that children can grow as normally as possible, and diet-related difficulties later in life are minimised. I also provide post-treatment support as needed until the age of 18.
Shared-care units usually access a dietitian as part of a general paediatric caseload. My post is therefore novel, created because the oncology caseload was exceeding the availability of the general dietitian. The benefit of me being allocated solely to oncology is that children receive an increased level of prophylactic input, rather than just being treated for acute presentations.
Macmillan provided the initial two years of funding for the post, and permanent NHS funding is now in place. The two years of Macmillan funding have given very promising results. Most notably, I used family questionnaires to assess the parents’ perceived impact of my post at baseline (19 respondents), and again after one year (11 respondents). The responses show that the parents feel the new service has had an extremely positive impact. The improved responses between 2013 and 2014 are shown below:
- Do you feel your child’s nutritional needs have been met? 68% to 91%.
- Is your child well nourished with a positive impact on their general well-being? 42% to 64%.
- Is your child poorly nourished with a negative impact on their general well-being? 26% to 0%.
On beginning the post, numerous concerns about the catering provision were immediately presented to me. I used surveys again to formalise this feedback, and worked closely with our catering team to overhaul the catering system. The initial system involved bulk regeneration at ward level, which was associated with unappetising, under/over-cooked meals, food being served cold, and lack of variety. The outcome of this work is the implementation of i-Wave, a new system that reheats meals on an individual basis. Now the children can choose from the full range of 14 hot main course options at any meal, which are freshly heated and taken to them immediately. Feedback pre- and post-iWave implementation demonstrates improved presentation, taste, temperature, palatability, variety, and overall quality. Parents now feel less need to bring their own food in which represents a cost saving to them.
I aim to continue improving my knowledge, ensuring all children have routine access to this service and using dietetic outcome measures to identify areas for further improvement. I also want to work with Macmillan to see how I can provide information in people’s own languages in this ethnically diverse area. Macmillan’s funding has now ended but the relationship has not, and I remain grateful for Macmillan’s expertise in the future development of this young service.
Macmillan Specialist Paediatric Oncology Dietitian
Lewisham and Greenwich NHS Trust