End of treatment workshop following breast cancer treatment: a survivorship initiative

Michelle Derbyshire and Caroline Misell, Macmillan Breast Care Nurses, City Hospitals Sunderland NHS Foundation Trust.

In July 2008, we developed a patient workshop, as it was apparent following treatment there is a significant gap in support. This became evident in the nurse led clinic as many ladies were struggling with menopausal symptoms, fertility issues, and problems with body image sexuality and with an ongoing fear of recurrence of the disease.

We wanted to:
• Provide an opportunity for ladies to attend a group session following treatment and to give them the tools and knowledge to enable them to face the future with confidence rather then fear.
• Explore and identify psychological needs using the distress thermometer and to action and signpost patients to the most appropriate avenue of support.
• To establish additional self-management workshops for six months to a year following treatment.

The service has now been utilised by 127 patients and has been evaluated extremely well. Due to patient demand we have developed a moving on workshop, a reconstruction workshop and a chemotherapy and Herceptin drop in session. The additional sessions have provided a more holistic approach to survivorship as it is carried out in a timely fashion before, during and after the survivorship transition period.

It is a mechanism to help survivors take greater control of their lives. Many of sessions are driven by patients' experiences and others take comfort in the fact they are not alone in removing the feeling of isolation and abandonment. The workshops focus on health promotion and self management leading to improvement in patients' anxiety. They can also be proactive rather then reactive to issues such as lymphodema or post-menopausal bleeds that can lead to better management when caught at an early stage.

The use of the distress thermometer has led to a more accurate assessment of psychological needs prompting referral for additional counselling or to a psychologist when needed. It is also a useful tool for other professionals involved in the patients' care as it gives them a better understanding of the psychological and physical needs of the patients.

We are constantly evolving and trying to identify any forgotten avenues of care. Currently we are in the early stages of developing a workshop for partners and husbands, as often they share the same anxieties of the patient. We also focus on the education of professionals involved in breast care such as physios, mammographers, dieticians and ward staff who may be unaware of the problems women face on daily basis following treatment. The professionals also have the opportunity to share their knowledge with patients, hence reducing potential appointments with GPs or other allied health professionals, as patients are far more confident at identifying and managing symptoms.

The demand for the moving on group has been overwhelming - approximately 90 per cent of patients attending the end of treatment sessions are then returning to the moving on group. This demonstrates the demand for support required following treatment. We hope other CNS practitioners see how valuable the sessions can be and be inspired to take action and improve patient care.

Our ultimate goal is that no women should feel abandoned or alone, and they have the sufficient tools to help them with on the road to recovery. The experience of cancer will never leave them but the fears and anxieties attached to the diagnosis can be managed with the good support and education.