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Cancer care at the front door: The therapies team

Kate Baker, Cathryn Lewis and Kate Williams are allied health professionals (AHP) working at the acute oncology (AOS) assessment unit in Velindre Cancer Centre, where AHP time is built into the funding model. In this blog they reflect on the benefits of a multidisciplinary (MDT) holistic approach to patient care.

Four years ago, Velindre secured Macmillan funding for allied health professional time on our acute oncology assessment unit. We have very much taken an MDT approach, and now the therapies team is completely integrated into the patient care that we deliver at the front door.

Therapy intervention in acute oncology not only helps to avoid admission into hospital, it also reduces length of stay and facilitates earlier discharge. We can help patients to self-manage their health by providing earlier intervention with fatigue, pain or breathlessness, and it can really enhance their quality of life. That’s what’s key to improving the patient experience. 

Velindre has an ANP-led assessment unit, with the ethos being a multidisciplinary holistic approach. As therapists, we screen patients who come into the assessment unit to identify their needs, reduce admission and provide early intervention. We carry out a small number of community visits: we’d like to expand those alongside our therapy-enhanced discharge service. We are still a very fragile team. We've grown over the years, but we are still fairly small for the services we're trying to deliver. Seven-day working is an ambition for the unit, because people still require assessment and possible admission on a weekend. 

We’ve worked hard to educate other healthcare professionals about the roles and the value of having AHPs on the unit. Four years down the line, we’ve proved our value and integrated ourselves as part of the MDT. Our role is to look at the bigger picture: treating patients holistically is absolutely key to preventing admission. After all, we aim to maintain safety, independence and quality of life. Patient experience has been very positive, and we get valuable feedback from the patients. To the outsider, it might look like an occupational therapist providing a commode is just giving them a piece of equipment. But the commode might prevent a night-time fall, therefore avoiding a hospital admission, which in the longer term, will have a positive impact on the individual’s quality of life. A significant proportion of AHP time is also dedicated to non-pharmalogical symptom management like breathlessness, fatigue, pain and anxiety, which are side effects of both diagnosis and treatment.

Collaboration is key. Velindre hosts a lunchtime AOS meeting for health boards in south-east Wales to look at complex cases, metastatic spinal cord compressions, and other acute oncology presentations, which really helps to build relationships with the health boards. We want to make those a central hub for advice and support, with formal notes made by the AOS coordinator. If we don’t have that meeting, things do tend to fall apart. The challenge now is to increase engagement and attendance from the AOS teams across south-east Wales to ensure shared learning. 

Initially, it was a big challenge to find space to house us all. You want the whole team to be co-located to enable those MDT discussions: that’s important. On any given weekday, there are medics, ANPs, nursing staff and a healthcare support worker, plus the visiting palliative care team and AHPs. 

We need to develop more specialist AHP knowledge in the health boards. When a patient is discharged home, they face a postcode lottery in accessing follow-up support from therapies. The digital infrastructure needs work too: patients don’t always come in with a transfer letter, so we have to spend time chasing the health boards for their medical and surgical history. That’s about improving processes and pathways and collecting the right data to make the case for investment. If we can measure the right outcomes, it's much more powerful to develop the service further.

Transport is another challenge. Moving patients between sites in a timely manner, particularly on the weekends, can be difficult, and delays can have a huge impact on patient outcomes and experience. 

Ideally, we’d also have access to a (metastatic spinal cord compression) MSCC coordinator for every health board. We need to ensure that patients are going for surgery when appropriate and in a timely manner. In Wales, we've never invested in MSCC coordinators, which puts pressure on the system and staff. Decisions aren’t being made quickly, communication is too slow, and we’re often missing our NICE targets. It's a big risk.

Things have changed massively over the past 10 years. AHPs in AOS were hidden a decade ago. Patients weren’t as complex and treatments weren’t as advanced as they are now. We’ve come a long way, but there are still challenges to ensure that AHPs are core to every AOS team. Patients are presenting at a later stage, especially post-pandemic, and the need for AHPs to improve quality of life will only increase. AHPs should be core members of the AOS team: we make a real difference to patient outcomes. 

Kate Baker
Macmillan therapies manager
Velindre Cancer Centre

Cathryn Lewis
Macmillan clinical lead for occupational therapy
Velindre Cancer Centre

Kate Williams
Specialist physiotherapist
Velindre Cancer Centre