Skin Cancer Nursing A Nursing Perspective from a Specialist Skin Centre Karen Pocock Skin Cancer Clinical Nurse Specialist St.Helens & Knowsley Hospital.

Skin Cancer NursingSkin Cancer Nursing

A Nursing Perspective from a Specialist A Nursing Perspective from a Specialist Skin CentreSkin Centre

Karen Pocock Karen Pocock Skin Cancer Clinical Nurse SpecialistSkin Cancer Clinical Nurse SpecialistSt.Helens & Knowsley Hospital TrustSt.Helens & Knowsley Hospital Trust

ContentContent Dispel mythsDispel myths Role of Skin CNSRole of Skin CNS Geographical boundaries Geographical boundaries Patient JourneyPatient Journey Which patients should be referred?Which patients should be referred? Referral process in to SSMDT Referral process in to SSMDT MDT Link – value ofMDT Link – value of Who are the SSMDT?Who are the SSMDT? The futureThe future SummarySummary

DispelDispel Myths - MacmillanMyths - Macmillan

Macmillan does not mean end of life!!!!Macmillan does not mean end of life!!!!

MacmillanMacmillan is a source of information for patients/families dealing with is a source of information for patients/families dealing with

cancer.cancer. is a source of information for health professionals working in the is a source of information for health professionals working in the

cancer field.cancer field. aims to improve the lives of people affected by cancer.aims to improve the lives of people affected by cancer.

Role of the Skin Cancer CNS within Role of the Skin Cancer CNS within the specialist Centrethe specialist Centre

Diagnosis – End of LifeDiagnosis – End of Life Link to all hospitals/teams/other skin CNSLink to all hospitals/teams/other skin CNS Clinical expertClinical expert A resourceA resource An educatorAn educator Change AgentChange Agent ResearcherResearcher AdvocateAdvocate

Nobles IOM Glan Clwyd Chester

Broad Green

Bangor

Southport

Ormskirk

CCO

Warrington

Halton

Wigan

Aintree

Geographical BoundariesGeographical Boundaries

STHK

Patient JourneyPatient Journey

Diagnosis (dermatology, plastics, GP)Diagnosis (dermatology, plastics, GP) Referred to Specialist Skin CentreReferred to Specialist Skin Centre Surgery (plastics)Surgery (plastics) Waiting for resultsWaiting for results Possible further surgeryPossible further surgery Scans, further investigationsScans, further investigations Possible referral to CCO - radiotherapyPossible referral to CCO - radiotherapy Possible referral to oncology - clinical trials, chemoPossible referral to oncology - clinical trials, chemo Possible referral to other specialist centres i.e. Christies, Possible referral to other specialist centres i.e. Christies,

Glasgow.Glasgow. Living with cancerLiving with cancer End of lifeEnd of life

CASE STUDYCASE STUDY

So how do we help?So how do we help?

Smooth patient JourneySmooth patient Journey Act as a link between all teamsAct as a link between all teams Communicate to other Skin CNSCommunicate to other Skin CNS Relieve patient/family anxietiesRelieve patient/family anxieties Point of contact / key workerPoint of contact / key worker Refer on to other teams throughout the networkRefer on to other teams throughout the network

• Lymphoedema nursesLymphoedema nurses• Counselling/clinical psychologyCounselling/clinical psychology• Prosthetics, PhysiotherapyProsthetics, Physiotherapy• Palliative carePalliative care• Holistic therapiesHolistic therapies

Which patients should be referred Which patients should be referred to the SSMDT?to the SSMDT?

Any complex skin cancer requiring wider excisionAny complex skin cancer requiring wider excision Wider excision & SLNBWider excision & SLNB Local recurrenceLocal recurrence Lymph node DissectionsLymph node Dissections Head & neck melanomaHead & neck melanoma MOHSMOHS OncologyOncology Discussion only for expert adviceDiscussion only for expert advice

See Network GuidelinesSee Network Guidelines

SSMDT Referral FormSSMDT Referral Form

All patients need to be referred via formAll patients need to be referred via form Clinical informationClinical information Send relevant investigations with formSend relevant investigations with form Fax to Barbara MarshFax to Barbara Marsh Listed for SSMDTListed for SSMDT Deadline Thursdays 12 noon for MDT discussionDeadline Thursdays 12 noon for MDT discussion Appointments generated via Barbara ASAPAppointments generated via Barbara ASAP

Barbara MarshBarbara Marsh01744 64677601744 646776

MDT Link – HUB of teamMDT Link – HUB of team RoleRole

Receives all initial referrals via faxReceives all initial referrals via fax Constructs MDT list Constructs MDT list Meets deadlines for cancer targetsMeets deadlines for cancer targets Makes referral appointmentsMakes referral appointments Chases investigations i.e. scans, histology Chases investigations i.e. scans, histology Uploads data to somersetUploads data to somerset Contacts patientsContacts patients Acts as a link to other trustsActs as a link to other trusts

The Team at STHKThe Team at STHK 2 MDT co-ordinators2 MDT co-ordinators 3 Core Plastic surgeons - specialists in skin cancer 3 Core Plastic surgeons - specialists in skin cancer

surgerysurgery 6 Dermatologists6 Dermatologists 1 Medical oncologist1 Medical oncologist 1 Clinical Oncologist1 Clinical Oncologist 2 Histopathologist2 Histopathologist 2 Radiologists2 Radiologists 2 CNS’s2 CNS’s 1 Research Nurse1 Research Nurse Variety of associate specialist surgeons/nursing/clerical Variety of associate specialist surgeons/nursing/clerical

staffstaff

The FutureThe Future

Continue to develop the service Continue to develop the service Nurse Led Clinics / clinical diagnostics in melanomaNurse Led Clinics / clinical diagnostics in melanoma Electro chemotherapyElectro chemotherapy Increased clinical trials portfolioIncreased clinical trials portfolio Patient led support groupsPatient led support groups

SummarySummary The Skin Cancer CNS is here as a result of the national The Skin Cancer CNS is here as a result of the national

cancer agenda, as with all other tumour sites.cancer agenda, as with all other tumour sites. The role of the CNS can enhance the quality of care The role of the CNS can enhance the quality of care

delivered to each individual patient with skin cancer by delivered to each individual patient with skin cancer by being their key worker.being their key worker.

The patient journey is complex, given the geographical The patient journey is complex, given the geographical boundaries of where they come from.boundaries of where they come from.

MDT co-ordinator is a main link to SSMDTMDT co-ordinator is a main link to SSMDT See Melanoma network guidelines for referral criteria to See Melanoma network guidelines for referral criteria to

SSMDT SSMDT We want to work together with all members of the team We want to work together with all members of the team

putting the patients needs first.putting the patients needs first. The patient is the most important person of all our work.The patient is the most important person of all our work.

Thank you Thank you