Throughout my career in cancer nursing, I have often found myself reflecting on how complex cancer care can feel for those who are confident in navigating healthcare systems. For people with a learning disability, these challenges can be magnified. Understanding information, attending appointments, coping with unfamiliar environments, and making decisions about treatment can all present additional barriers at an already difficult time. Over the years I have seen the vulnerability of people faced with systems that were not designed with their needs in mind, but also witnessed their resilience in these circumstances. It is experiences like this that stayed with me and shaped how I felt, and continue to feel, about personalised care.

The 2025 LeDeR report on Avoidable Cancers highlights the inequalities faced by people with a learning disability and cancer, including poorer outcomes and later diagnosis. Behind the statistics are individuals whose experiences of care do not always reflect the standards we aspire to. For me, this brings into focus the importance of not only recognising inequality, but addressing it.

This prompts reflection on a simple but important question: are our services designed around the needs of the people using them, or are we expecting people to adapt to the way our services operate? Whilst this may feel like an uncomfortable question, it’s an essential one if we are serious about equity in cancer care.

In my role as Macmillan Lead Nurse for Personalised Care, we have explored what this means for the patients under our care at East Kent Hospitals. We began with a staff survey, which led to targeted education sessions, promotion of communication tools, and closer working with other services to understand and address barriers throughout the wider cancer pathway. One of the most important lessons this work has taught us is that staff want to provide excellent care, but often lack confidence in how best to support someone with a learning disability. Many colleagues shared that they felt worried about doing the wrong thing, therefore creating a safe space for colleagues to come together to have those conversations has been a crucial part of this work.

Our work found that the challenge was rarely a lack of compassion or willingness to help. Instead, staff were asking for practical advice and greater confidence in making reasonable adjustments. This highlights an important opportunity for cancer nurses to support each other, share good practice, and create environments where accessible care becomes everyone’s responsibility. Peer learning can be so powerful, and through this work I saw small conversations between multidisciplinary colleagues leading to meaningful changes in practice.

The small changes can have a significant impact. Reasonable adjustments such as longer appointments, quieter waiting areas, and access to easy-read information - such as that provided by Macmillan Cancer Support or tumour-specific charities - can make a real difference. Involving carers, completing hospital passports, and understanding what matters to patients, their carers and families before they enter the room can transform the care experience. Something as simple as taking a few extra minutes to prepare or adapting how we communicate can reduce anxiety and help patients feel more in control of their care.

As nurses, we are often the professionals who know our patients best. We coordinate care, advocate for individuals, and identify barriers that others may miss. This places us in a unique position to champion equitable care for people with a learning disability who are navigating a cancer diagnosis. Our role requires us to be both curious and reflective, but also to challenge assumptions that we or others may hold.

The goal is not to create a separate cancer service for people with learning disabilities. Rather, it is to ensure that our existing services are flexible, compassionate, and accessible enough to meet the needs of everyone who uses them.

If there is one thing this work has reinforced for me, it is that inclusion is not about big gestures, but more often it is achieved through small, thoughtful adjustments that support people to participate fully in decisions about their care. As cancer nurses, we all have a role to play in making that happen.

As Learning Disability Awareness Week asks us, “Do you see me?”, perhaps the challenge for cancer nurses is to ensure that every person affected by cancer feels seen, heard, and valued throughout their care, in every interaction and every appointment, and in every decision we make alongside them.