Living with cancer – how to support patients through treatment and after-An oncologists perspective

Dr Kiruthikah Thillai

Consultant Medical Oncologist

Guy’s and St Thomas’ NHS Trust

Mind and Body Lead for the Guy’s Cancer Academy

5 year survival

All Cancers Excluding Non-Melanoma Skin Cancer (C00-C97 Excl. C44): 2010-2011Age-Standardised Five-Year Net Survival, England and Wales

Different cancers- different outcomes

• Metastatic melanoma – 10 years ago – 5 year survival was around 5%

•One in Two Patients With Metastatic Melanoma Alive After 5 Years

– ESMO Sept 2019

– Newer treatments-different side effects

– Ongoing – maintenance treatments

– So varied – personal treatments

– Are we keeping up with the advances in advances in treatments?

Case Study Ms SF

• 41 year old

• Ex smoker, moderate amounts of ETOH

• 3 month history of

• Weight loss

• Loss of appetite

• Low mood

Ms S.F.

Saw GP 4 times over 3 months

Discussed mood -diagnosed with depression

Started on citalopram

No change in symptoms

Declined counselling

Stopped citalopram

DNAd several appointments

6

Diagnosis

Admitted to hospital with painless jaundice

Told her diagnosis whilst alone on the acute medical post take round

Dr Google – 5 year survival for stage 4 pancreatic cancer (3%)

7

Pancreatic Cancer (C25): 2010-2011Net Survival up to Ten Years after Diagnosis, Adults (Aged 15-99), England and Wales

Please include the citation provided in our Frequently Asked Questions when reproducing this chart: http://info.cancerresearchuk.org/cancerstats/faqs/#HowPrepared by Cancer Research UKOriginal data sources:Survival estimates were provided on request by the Cancer Research UK Cancer Survival Group at the London School of Hygiene and Tropical Medicine. http://www.lshtm.ac.uk/eph/ncde/cancersurvival/

Case Study Ms. SF

• Seen in clinic

• Told incurable pancreatic cancer

• Overall survival around 11 months

Palliative chemotherapy

• FOLFIRINOX• Standard chemotherapy

• 3 drug combination

• PICC line – visual daily reminder

Consented

On chemotherapy, good response on imaging

• 3 months of chemo – good response-continued to an ‘on treat clinic’

• Seen every 2 weeks – no opportunity to discuss how she actually was ( no CNS in this clinic)

– QOL data

– PRODIGE study –

• Improved QOL based on EORTC QLQ-C30 scales that are usually most affected in patients with

pancreatic cancer (global health status [GHS], fatigue, pain, physical functioning (PF), emotional

functioning, and role functioning)

What mattered to her?

• Death

• Fatigue-not being able to enjoy the time she has left

• Ongoing low mood*

• Amount of time spent in hospitals

• PICC line

• Hair loss

• Body image

• Fertility

• Sex

• Dating

*Super complicated!

Pancreatic cancer and

depression –strong links – more

research needed

What can we do?

• EDUCATION!!!

• Much more multi-professional learning

• Much more tailored care for patients (more patient focused!)

– Different ages

– Different genders

– Different ethnic groups

– Different socio-economic groups

Guy’s Cancer Academy

• Educational branch of Guy’s Hospital and Guy’s Cancer centre

• Funded by Guy’s Cancer Charity

• Focuses on multi-professional education

• Patient focused – all projects include patients as co-researchers/Co-designers

• Different work streams

– Mind and Body

The link between Mind and Body

Design educational resources for staff and patients that will

cover

• The psychological needs of patients with

cancer

• Understand holistic care

• Address our diverse patient population and the

different needs of our patients

• Promote well being in our staff

Mental health and cancer

• Anxiety – occurs in 20 % of patients with cancer

• Depression – occurs in 10% of patients with cancer

• This is regardless of

– Cancer trajectory

– Palliative vs curative treatment

– Not just reactive!!

Patient-

centred

projects

In-DEPTH (holistic

needs

assessments)

Communication

skills

Sex/Relationships/

FertilityPromoting

diversity

Develop online

resources for

patients

Mental health and cancer

• Current – oncologists identify patients with needs – refer to psychology/psychiatric services

• NEW

– Patients fill in validated questionnaires

– Refer to services appropriately

– Highlight individuals needs

– Educate multi-professional staff

Pancreatic cancer and depression

• Retrospective studies looking at mental health records and correlate with

pancreatic cancer diagnoses

• Prospective work in oncology clinic – screening tools for depression

• Monitor depressive symptoms – correlate to outcomes and treatment responses

Innovative co-Design and Evaluation of care Plan Training and education for Holistic needs (InDEPTH)

• Improve the use of Health Needs Assessments (HNAs)

• Develop and deliver training to support completion of person-centred,

individualised, HNAs and care plans

• Standardise completion of HNA care plans to address inequalities in

experience and outcomes for people following a cancer diagnosis

• Develop online resources

Diversity

• Understanding the diverse population that we serve in GSTT

• Recognising that different patients have different experiences

• Age/Gender/Ethnicity

• Focus groups – address patients needs

• Individually-tailored cancer care

Developing understanding about the impact of cancer on body image, sex and relationships 4/2/20

• Important we understand the effects that cancer and treatment has

on body image

• Effects on fertility – newer treatments with different side effects

• Need to talk more about sex! (and relationships)

• One-day event for patients and staff – discussing patient

experiences and seminars from experts

Tackling staff ‘burnout’

• Increasing pressures on our staff

• Often managing challenging situations

• Important to promote well-being amongst staff

• Psychologist-led group sessions for junior doctors – reflection

• Developing education and training for administrative and clerical staff

• Supporting our teams

To summarise

• Educate staff about holistic approach to treating cancer

• Focus on mental health

• Shameless promotion of ‘Sex, fertility and relationship’ day!!

Thanks to Guy’s and St.Thomas’ Charity for funding

Guy’s Cancer Academy for the first 3 years.

Email Kiruthikah.Thillai@gstt.nhs,uk

Twitter – @KiruthikahT