breast radiotherapy rehabilitation injury service a national multi-disciplinary service for...
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Breast Radiotherapy Rehabilitation Injury Service
A national multi-disciplinary service for consequences of breast radiotherapy
Denise Moorhouse RGN
Specialty Manager – Pain services
Royal National Hospital for Rheumatic DiseasesNHS Foundation Trust, Upper Borough Walls, Bath, BA1 1RL
• Two million people in the UK with a diagnosis of cancer - set to grow to 3 million by 2030
• Approximately 17 000 people are treated with radiation therapy in the UK every year and an estimated 80 000 are alive
• 2007 National Cancer Survivorship Initiative launched
• “Most modern surgery, radiotherapy, chemotherapy and biological treatments can have consequences which develop immediately, or become apparent years, or even decades later.” Maher 2013
The Context
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Cancer Survivorship
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At the end of Cancer treatment…
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Individuals receive follow up according to their needs. •Most people will manage with open access to services•Some will require shared care between agencies•Few will be complex and require more intensive input.
Breast Radiotherapy Injury
Neuropathic pain
Lymphoedema
Osteoporosis and bone loss
Impaired lung function
Anxiety and depression
Impaired function
Why/How did these clinical problems arise?
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• Historical cohorts
• Random choices of RT dosages and delivery
• Lack of evidence base, national protocols or treatment guidelines.
• Lack of modern techniques
• Inconsistent positioning therefore some areas of breast tissue/ axilla & supraclavicular nodes were over exposed
The Funded National Service
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•Following evaluated pilots, the service was established
•NHS England funding – no costs to GP’s
•Now recruiting patients into the service very specific criteria
•Service available to everyone registered with a GP in England
National Service – Patient Journey
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OR
Referral
Accepted onto caseload by Prof Candy McCabe, Clinical lead @ RNHRD
Telephone Assessment by RNHRD
Do not meet criteria discharged back to GP or signposted
2 Day MDT Clinic: Day 1 Oncology, Pain, Rheumatology, Respiratory, Specialist OT and PT, Psychology Day 2 Therapist deliver strategies to the group
3 month follow up 2 week residential programme OR
Inpatient Rehabilitation Service
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RNHRD specialist rehabilitation hospital in the centre of Bath Two week individualised programme includes
• Daily physiotherapy, hydrotherapy and occupational therapy
• Psychology and pain management available as required
Aims of National Service
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3 main clinical outcomes:
• Improvement in daily function
• Improvement in quality of life
• Improvement in pain management
To build a knowledge base about this rare condition
To provide support and education to health care providers on safe management of this condition
Outcomes so far
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• Evaluated using various measures which include:
• Brief Pain Inventory – Short Form (severity & impact)• Upper Extremity Functional Index• PHQ-9 Depression• SF36 Health Status
• Outcomes collected at baseline, 3 months and 12 months• Patient feedback collected after 2 day clinic, 3 and 12
months
• Outcomes and feedback also collected pre/post inpatient stay
Outcomes so far
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• Data collected at three months on 66 women shows that compared to baseline:
• 68% of women reported a reduction in pain severity
• 81% reported less of an impact of pain on their lives.
• 66% of women reported an improvement in upper limb function
• 68% reported an improvement in mood.
• 67% reported an improvement in social functioning and 35% reported an improvement in their general health.
Breast Radiotherapy Injury Rehabilitation Service Outcome Data
Royal National Hospital for Rheumatic Diseaseswww.rnhrd.nhs.uk
Postural / Positional Improvements
Patients natural posture. After one session of education, in a corrected position.
After 2 weeks of rehabilitation.
Patient feedback
“The dedicated time with specialists who understood exactly what my issues were was fantastic. Thank you”.
“To know that I can still be helped after so many years was really rewarding, just wish this service had been available before now”.
“This was a very positive experience, it is fantastic that the late effects have been recognised and addressed. It is also nice to know that our experiences may help others”.
Referrals
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Professor Candy McCabe
RNHRD
Upper Borough Walls
Bath
01225 473462