A typical day in the life of an AOS cancer specialist...

Cancer patients may need an emergency admission to hospital due to complications from their disease. But there is a team of staff on hand to help this group of people, as Charity Macmillan Cancer Support explains...

LOCATED on the sixth floor of Block A at University Hospital of Wales (UHW) is the Acute Oncology Service (AOS).

The service, funded by Macmillan Cancer Support working in partnership with Cardiff and Vale University Health Board, was set up in April 2015 and is already making a positive, measurable impact on the experience of cancer patients.

The AOS team supports cancer patients admitted to hospital as an emergency, as well as those who are acutely unwell from the disease.

Symptoms may be the result of a complication of their cancer, from side-effects caused by their cancer treatment (chemotherapy or radiotherapy), or the patient may have a new cancer diagnosis.

The Macmillan team is headed by acute oncology clinical lead, Dr Diane Parry. Acute oncology nurse practitioner Jane Whittingham leads a team of three acute oncology specialist nurses – Sophie Norton, Sally Jones and Sarah Grady – and the clinical team is supported by service coordinator Rohie Khan.

Although there’s no such thing as an average day, Monday morning presents a greater challenge as the team also deal with weekend admissions. meeting when they run through their current patient or new patient list. It is an opportunity to ensure that patients are on the correct clinical pathway.

Not all patient referrals are generated from the electronic list.

Jane receives a phone call from an emergency unit nurse about a patient in her early 30s with severe chest pains who is undergoing treatment for cancer of the uterus. Initial information is scant and Jane uses CaNISC (an online computer system holding information from a patient’s interactions with health professionals) to access notes, x-rays and treatment plans so that she can accurately assess the patient.

The team go through the current patient list and the AOS nurses then leave for the wards.

The service has a target of meeting patients within 24 hours of referral.

Rohie remains in the office to update records and follow up patient scans.

The AOS nurses act as the expert oncology opinion and liaise directly with patient oncologists. For example, they email Velindre Cancer Centre to let oncologists know that their patients have been admitted to University Hospital of Wales. They also feedback oncologist advice.

Increasingly, the team are also using video conferencing to improve direct communication.

Jane explains: “By having video conference in the office, we’re able to link in and hear first-hand the conversation in Velindre about our patients. We’re able to present the patients ourselves instead of it happening second-hand via the registrar, which is what used to happen.”

More and more emergency unit doctors and nurses in the hospitals are contacting the AOS team for advice and support with cancer patients.

“We’re getting somewhere now,” says Sophie. “It takes a while to get to know everyone, especially in a big hospital like this and we’re just getting established.”

In May 2015, the AOS service received 16 patient referrals. By May 2017, this number had increased to 693 patient referrals.

The current AOS service has an advisory role and operates 9am to 5pm, Monday to Friday. Future potential developments may include a ward with dedicated inpatient beds for AOS cohort patients to receive expert care from a specialist cancer care team.

The AOS nurses spend the rest of the afternoon visiting patients but, in quieter times, the team focus on developing the AOS service.

After a final catch up, Rohie heads home.

Unusually there are no last-minute calls for the team.

Confident that there are no more patients to see, the team finish their working day as Jane makes one final check on the patient with cancer of the uterus.

The patient is out of the emergency unit and has now been moved to the appropriate ward best suited to treat her symptoms.

“Getting people back on the right clinical pathway – that’s what makes the job worthwhile,” reflects Jane.

If you have questions about cancer, call the Macmillan Support Line free on 0808 808 00 00 (Monday to Friday, 9am to 8pm) or visit the Macmillan website at www. macmillan.org.uk