“All the things I never thought I’d do again – I’m doing them!” Breast Radiotherapy Injury Rehabilitation Service Complex Cancer Late Effects Rehabilitation Service Managing cancer as a long term condition Specialist, intensive, tailored rehabilitation for those living with complex late effects of cancer

Breast Radiotherapy Injury What are the problems and what do we do? Therapeutic Aim For the person to:- Achieve full functional potential Identify unhelpful strategies which have developed over time and become confident to take action to correct them Become autonomous in managing the impact of pain and other symptoms on daily life Re-engage in meaningful and purposeful occupations which promote increased health and wellbeing Develop self efficacy Breast Radiotherapy Injury Common presentation Neuropathic pain Atrophy Altered sensation Decreased power Decreased range of movement Altered biomechanics Fatigue Breathlessness Reduced function Emotional difficulties consistent with living with a long term pain condition following cancer treatment

Service Model CNS Triage Assessment 2 day clinic 2 week therapy led residential programme 3,6,12 month follow up Rehabilitation Programme Groups, workshops, 1:1 work Daily Occupational Therapy Daily Physiotherapy Daily Hydrotherapy Psychology access Pain Consultant access Clinical Nurse Specialist access

Outcomes 100% ↑ in performance of valued tasks 100% ↑ in satisfaction of how they were managing these tasks 70% demonstrate clinically significant performance outcomes 100% demonstrate clinically significant satisfaction outcomes

Macmillan funded pilot scheme: Complex Late Effects 20 patientsclinic 19 women, 1 man Av age 60 years Av 12 years post D 42% had recurrence Half attended programme Refs: self, CNS, surgeon Outcomes 49% ↓ GP visits 34% ↓ pain Drs 20% ↓ pain severity 38% ↓ pain interference 57% ↓ depression 24% ↑ clinically sig UL function

“my faith in anything happening had gone, my attitude was just to try and get on with it, but it’s given me the understanding that things can change” Breast Radiotherapy Injury Rehabilitation and Complex Cancer Late Effects Rehabilitation Services Tel: Kim on 01225 473481 to refer – it’s simple! rnh-tr.BRIRS@nhs.net https://www.youtube.com/watch?v=bphfVNu453A