Ingrid Fuchs Cancer Nursing Award

The nature of cancer care is constantly changing as new forms of treatment are introduced to try and improve survival rates. However, cancer remains a devastating disease and patients need both skilled clinical care and intensive support while receiving treatment and, increasingly, in managing the long-term effects of the disease after treatment. Nurses are the linchpin of the cancer care team, managing complex new treatment regimens, coordinating care and ensuring patients receive timely diagnosis and treatment. They are also the professionals that patients turn to for emotional and practical support, and they need to be able to offer this in a compassionate manner and adapt it to individual patients’ needs.

Barking, Havering and Redbridge University Hospitals NHS Trust
Enhanced supportive care team

Implementing a Nurse led Enhanced Supportive Care (ESC) Service. A baseline audit at BHRUT identified that only 30% of patients diagnosed with incurable cancer were referred to a palliative or supportive care service at point of diagnosis of incurable disease. Sadly this meant that the remaining 70% of patients could not access the expertise and support of palliative care specialists until they were either admitted to hospital in crisis or were in the last weeks of life. Internationally it has been identified that earlier involvement of supportive and palliative care in cancer care results in better outcomes for patients, including the potential to extend their survival. Our vision for ESC was to to bridge the gap between oncology and end of life care for our cancer patient and carers. This is achieved through early identification of eligible patients from weekly site specific MDTs and this process triggers automatic referral to ESC. Our challenge was implementing a nurse led ESC team within a trust that already had a well established palliative care team. By ensuring robust engagement with all cancer professionals on a regular basis, responding to feedback and concerns our nurse led vision became a reality. It was imperative that the wider team understood our goals and the overall aim of improving cancer patient experience. The unique selling point being that we would be proactive not just reactive, by supporting our patients with or without a specialist need. We have the foresight and experience to know that patients needs will change throughout their cancer trajectory. Initially at set up we offered ESC to 3 tumour groups and with team success and expansion we now offer ESC to 5 tumour groups. Our future plan is to continue team expansion to ensure all tumour groups have access to ESC.

Calderdale and Huddersfield NHS Foundation Trust
Neuroendocrine tumour specialist nurse service

An oncology nurse identified that there was no site-specific specialist nurse for patients living with or being treated for neuroendocrine cancer (NET) patients at a District General Hospital (level, despite treating a significant number of patients within the local area. This meant that NET patients had no specialist nursing support or access to Macmillan Holistic Needs Assessments, that there was extremely limited awareness of the illness and that they are at risk of Carcinoid Crisis, which is a life-threatening complication. Following the nurse's voluntary pilot study, business case and championing this cause for two years, Macmillan, kindly pump-prime funded their project for a NET Specialist Nurse service at the local trust. The service has shown an increase in support for the patients, with nurse-led clinics, early intervention to speed up a complex diagnostic process and support patients through this. Alert cards and information, and the service phone number for support and nursing assessment were provided. Following the success of this service, from a qualitative and quantitative perspective (see attached) a clinical need has been identified and application has begun to continue this, a further DGH trust is also considering utilising this initiative. All patients were screened for nutrition and around half were at risk of malnutrition. The nurse worked with external dietetic professionals, to improve outcomes, and, to detect Pancreatic Enzyme Insufficiency and prescribe Creon for those where appropriate as >10% of patients were identified following assessment. A further goal being explored, is to expand the service, to include in-house dietetic and administration support, as this is currently a solo project In the coming months the initiative aims to work further with diagnostic services and provide education to GP's to raise awareness, to help to improve early diagnostics, to further improve outcomes.

Countess of Chester Hospital NHS Foundation Trust
General surgery cancer pathway improvement project – implementing a faster diagnosis team to carry out gastro triage (UGI and LGI)

The Countess of Chester Hospital NHS Foundation Trust is a 600 bedded Hospital serving more than 445,000 people a year, sitting within the Cheshire and Merseyside Cancer Alliance (CMCA) Gastro intestinal (GI) cancer is one of the largest groups of patients. The aim of the initiative was to improve patient experience of care and support delivery of NHS Constitutional standards, namely the Faster Diagnosis Standard (FDS) through optimisation of the Trust’s approach to the management of Urgent Suspected Gastro Cancer Referrals from referral through to diagnosis or exclusion of cancer and treatment. The operational standard of 75% for the proportion of patients diagnosed or ruled out within 28 days of referral had not been achieved between August 2021 to July 2023. When teams are challenged there can be a belief that the solution lies in an increased workforce. Capability and capacity were identified as factors in achieving the standards and CMCA were approached to support with resources to increase the Clinical Nurse Specialist (CNS) workforce, however, Kate Holloway the GI Lead Nurse recognized that workforce was not the only barrier and taking a whole systems approach to identifying the issues would ensure that an equitable and sustainable solution could be found benefitting patients and their carers . In collaboration with CMCA she examined the pathways, in relation to CNS activity. By taking this approach, Kate identified barriers and what could be done differently before identifying solutions and workforce requirements leading to a decision to invest in a dedicated Band 6 CNS for Faster Diagnosis Standard and support worker time. Positive results are already evident and the recruitment of the FDS nurse will enable the team to improve patient communication and focus on other areas eg increasing support to ward teams to improve patient experience and outcomes.

Newcastle upon Tyne Hospitals NHS Foundation Trust
NCCC ambulatory care – streamlining treatment pathways in acute myeloid leukemia

Ambulatory Care in the Northern Centre for Cancer Care (Freeman Hospital) is a nurse-led department and team dedicated to providing the highest standards of nursing care to patients underdoing treatment for oncological and haematological cancers, other haematological (non-malignant) diagnoses and also providing best supportive care to palliative patients who have exhausted all available treatment options. We have developed a number of pathways which allows patients to spend more time out of hospital, receiving day case treatment where possible, in order to improve their treatment pathway. We have recently streamlined the protocol and pathway for giving our patients Venetoclax (oral chemotherapy) and Azacitadine (sub-cut) in order to ensure that their care is straight forward, easy and patient-centred. This treatment is given over 5 - 7 days and the patients must attend daily for chemotherapy injections, meaning that they already have a lot of planned visits into hospital. As a team, we hoped to develop this in order to provide a service which allowed patients to have some freedom with their appointment times, ensuring their treatment is ready for them arriving and to ensure that each appointment is as short as possible. This treatment was previously given in a number of settings, meaning that patients had very little to no continuity at all, often experiencing problems, delays and ultimately meaning they were spending more time in hospital than necessary. In order to streamline the care these patients received, we moved all of their treatment cycles to Ambulatory Care. This patient group is now managed through our department by our team which includes band 6 and band 5 nurses as well as support from the AML Band 6 Nurse Specialists. We strive to coordinate care exceptionally to keep patients at the centre of everything that we do.

Royal Devon University Healthcare NHS Foundation Trust
Enhancing oral hormonal therapy treatment among breast cancer patients during the five-year treatment period following surgery

Issue to Resolve: Breast cancer treatment effectiveness hinges on patient adherence to prescribed hormonal therapy (HT). This project aimed to improve adherence during the five years following surgery to enhance patient outcomes, particularly for post-menopausal breast cancer patients. Approach: We established a nurse-led clinic to provide tailored services addressing the multifaceted challenges faced by these patients. The clinic offers a comprehensive range of support, including medical, psychological, and complementary services, guided by a newly developed standard operating procedure for the Breast Clinical Nurse Specialist clinic. Key strategies included enhancing communication channels, adhering to ethical guidelines, engaging stakeholders, developing leadership, and implementing a system for continual improvement. Challenges and Outcomes: We faced several challenges, including time constraints and data collection errors. However, the initiative saw positive outcomes, such as high patient satisfaction with a three-month telephone follow-up and positive staff feedback on reducing impromptu calls and anticipating problems. The project also addressed gaps in the literature by developing interventions based on existing evidence and best practices. These interventions included educational programs, shared decision-making tools, and innovative resource management approaches. We implemented and evaluated these interventions through pilot studies, monitoring, and assessing patient outcomes. Nurse-led follow-up care optimised service delivery, reduced outpatient resource strain, and ensured high patient satisfaction. Barriers such as the time and financial costs of in-person appointments were mitigated through alternative approaches like telephone consultations, which reduced travel and enhanced accessibility despite some communication challenges. Future Plans: Moving forward, I plan to expand the nurse-led clinic's services, continue refining our communication strategies, and further develop training programs to enhance staff competencies. By continuing to address gaps in the literature and improving resource management strategies, I strive to further enhance patient adherence to HT, ultimately improving breast cancer treatment outcomes and overall patient care quality.

Sheffield Teaching Hospitals NHS Foundation Trust
Nurse-led late effects screening service

Modern cancer management is an impressive medical success story. The goal of treatments maximises efficacy and minimises toxicity. Trade-offs include co-morbidities, impacting quality of life. Late effects may occur weeks, months or even decades later, can affect any system, may be physical, emotional, social or financial and include second cancers. The earlier late effects are identified, the sooner and more effective the intervention. Cancer nurses are ideally placed to work holistically to assess and screen for potential late effects and patient concerns. We have established a Sheffield Nurse-led Late Effects service to do just this. A key senior nurse leader worked collaboratively with multi-professional colleagues across multiple specialties to extend an established paediatric service into haematopoietic stem cell transplantation by implementing international guidelines, the first in Europe. The appointment of a dedicated Clinical Nurse Specialist embedded care into pathways. A further nurse-led late effects clinic was established within oncology focusing on adults of fertile age and survivors of solid cancers. Whilst these services grew, novel therapies were developing in parallel and presenting with their own novel toxicities. A more recent opportunity for a further senior nurse appointment enabled the transferability into immunotherapy late effects. Oncology faces significant challenges with increasing demand, an overstretched workforce, growing elderly demographics. Within this context, late effects services never represent burning platforms. We have persisted by raising the profile of our work and advocating for patients with evidence, tenacity and dedication. We are currently writing a late effects strategy for the regional cancer alliance. We have extending our Community of Practice working with radiography colleagues to pilot a Pelvic Radiation Late Effects Clinic and within haematology, recruited a Clinical Nurse Specialist to support a Late Effects Clinic for Multiple Myeloma. A successful research grant will develop a digital monitoring pathway for immunotherapy late effects.

Suffolk GP Federation
The Very Important Invitation Project

This project was initially set up with the aim to increase the uptake of cervical screening across Suffolk. General practice data suggested that most practices across the county were achieving between 74%-77% coverage of cervical screening uptake. We developed a training package for primary care whereby we produced two training sessions. One aimed at reception/admin/care navigator staff and one session for practice nurses or clinical members of staff who undertake cervical screening as part of their job role. Alongside this, we created a working tool kit for practice staff to be able to refer back to if and when needed. We recognised the importance for practices to achieve their 80% coverage targets but this made us want to look further into the 20% of the non attenders to see whether there was any outreach work which could be done in the community. This allowed us to hone our primary care education package to have a particular focus on health inequalities and to raise awareness of underserved communities by reducing barriers. Further to our support for primary care, we started networking and building relationships within the VCFSE sector. In particular, organisations supporting the LGBT+ community, local churches covering different faith communities, people with learning disabilities, physical disabilities and/or serious mental health issues, the travelling community, people from black, asian and mixed ethnic backgrounds, those living through deprivation and/or homelessness and people who have a history of abuse or trauma. This allowed us to be able to provide health promotion and education sessions as well as tailored support in accessing cervical screening to individuals most at risk of health inequality. Further to this the project also provides education sessions to secondary schools about HPV and cervical screening awareness as the research points to early education being paramount.

Tameside and Glossop Integrated Care NHS Foundation Trust
Macmillan advanced cancer specialist nursing service

In recent years, there has been an increase in the number of patients diagnosed with advanced cancer, which has been exacerbated due to diagnostic delays which occurred as a result of the COVID-19 pandemic (Maringe, Spicer, Morris et al., 2020). The needs of individuals with advanced cancer and their families are often reported as unmet, and require an individualised approach to improving each person’s experience (Wang, Molassiotis, Chung et al., 2018). Within our Trust, a review of complaints received from patients or relatives for those with advanced cancer showed that the care provided in our organisation often did not meet these needs, and could be much improved. To address this the Macmillan Advanced Cancer Clinical Nurse Specialist service was developed to support the delivery of personalised care and improved patient experience whilst providing a point of contact for this patient group. It aims to do this through the provision of a specific pathway to provide personalised support to patients with advanced cancer and their families, particularly those likely to transition into palliative care but have no specialised needs. Through delivery of increased numbers of holistic needs assessments offered to patients, including offering these to carers and family members where required. Also by improved access to and the quality of health and wellbeing information and support for patients who sit under the remit of this role, ensuring equity of care. The service aims to improve communication across the local health economy and dissolve barriers with public sector and voluntary sector organisations to deliver holistic care to the patient. In the future the team will lead on evaluating and improving patient experience in the context of complex cancer care. whilst leading on education, ad upskilling the existing cancer workforce and wider teams to maintain consistent standards of care.

The Clatterbridge Cancer Centre NHS Foundation Trust and The Cheshire and Merseyside Cancer Alliance
The teenage and young adult faster diagnosis project

Cancer is one of the biggest causes of death in young people (16-24years), more progress needs to be made to improve outcomes for this age group. This initiative aimed to improve the early diagnostic pathway for Teenage and Young Adult (TYA) patients with the introduction of a TYA Clinical Nurse Specialist. This was in line with the NHS Long Term Plan and the ambition that 75% of cancers will be diagnosed at an early stage and consequently 5 year survival would increase. The local cancer alliance supported a 2 year pilot project across 3 large trusts in the network. The role would support TYAs undergoing investigations for suspicious symptoms of potential malignancy. This early period of a TYAs cancer pathway has been evidenced as a period of increased anxiety, accompanied with daily uncertainty and stress of not knowing what may be wrong with their bodies or what would happen. An ongoing challenge within TYA care, is that there is not a ‘TYA cancer’ but up to 88 different types of cancer within this age group. Cancer presentation in young people is often not straight forward, TYAs may cross multiple pathways and specialities en route to diagnosis. Making an impact on TYA pathways is not an easy task. A significant challenge is a single person role across several sites. The ability to seek out TYAs in complex health systems using information methods and nurse initiative has been key. Developing and maintaining collaborative relationships has been significant to success. In the future we anticipate expanding the service across network trusts. Further utilise the position of being involved in cancer pathways at an early stage to allow TYAs to access genomic sequencing, tissue banking and clinical trials. Provide professional education to primary and secondary care to increase the awareness of young people’s cancers.

The Royal Marsden NHS Foundation Trust
Softies in diverse skin-tone

Expanding access and providing equitable care to meet the needs of individuals from ethnic backgrounds undergoing mastectomy for breast cancer without reconstruction. Applied for funding via a funding stream supported by The Royal Marsden Charity and set a pilot project. The main challenges was accessing data to substantiate the issue identified and appropriate provider to collaborate with. Fortunately, there was a national survey which had just been released of 100 women from ethnic backgrounds who had received cancer treatments. Of note, 74 percent of the respondents identified not being given appropriate prosthesis post-surgery was concern and lapse in care for them. We were able to support our application with this data to inform the degree of the issue and why such innovative project was needed. The plans for the future is to ensure wider provision and access within the NHS for all patients irrespective of the trust they are being treated at.

Velindre University NHS Trust
Innovative nurse-led post radiotherapy follow up clinic

Prior to starting this new nurse led clinic Sarah (my colleague) and I would support the consultant led follow up clinic. Each patient was allocated a 10 minute appointment. Within that time we would have to carry out the consultation, perform a vaginal examination and address all their holistic needs. It became apparent that it would depend on who the patient saw as to how their holistic needs were met. Many patients were rendered into menopause and would not have these issues addressed, many patients would have psychosexual issues with possible vaginal toxicities and their needs were being inconsistently met in a clinic slot that was not adequate to carry out a thorough consultation. The clinic started with its focus being on patients having had pelvic radiotherapy for a cervical or endometrial cancer. We would see them 6 weeks post Radiotherapy address questions surrounding diagnosis, treatment related toxicities, end of treatment summaries, holistic needs assessment and examination prior to referring back to local follow up or requesting end of scans. A project proposal was presented to the gynae team where we invited the Out patient manager and medical records team. It was agreed and we were able to establish clinic capacity and new clinic code. There was some apprehension about the length of clinic time and that we would be leaving the consultant led clinic but the team were supportive. It was agreed that we would audit the service after 6 months to gain patient feedback. We have had excellent feedback from a survey with response rate of 51% therefore the team are keen that this is offered to all patients who have had undergone radical radiotherapy for a gynaecological cancer. We are currently looking to expand.