1. TYA Designated Hospital perspective
Wendy Ansell
Macmillan Urology CNS
Barts Hospital

2. Background
Uro-oncology – specialist team for testicular & other germ cell cancers
Haem-onc specialist teams
Gynae cancers
Breast cancers
Others – e.g. ophthalmology
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3. Structure of discussion
Diagnosis
Time to treatment
Inpatient – ward environments
Day care treatments
Outpatient appointments
Telephone clinics
Access to trials
Palliative care
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4. Diagnosis & time to treatment
Timescales to start treatment
Specialist treatment or specialist surroundings??
Liaison with specific TYA team
Site specific MDT discussion
TYA MDT discussion
Numbers
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5. Inpatient care (1) Staff opinions Environment Facilities Nursing AHP’s
Medical
Other e.g. psychologists
Environment
Facilities
Computer access
Wi-fi
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6. Inpatient care (2) Comments from patients: What they liked:
Single room
Accommodation for families
Continuity of staff
What they didn’t like:
Being in a bay with older, ill people
General comments – not particularly needing interactions with other patients
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7. Day care Recliner chairs + a few rooms with 1 or 2 beds
Timed appointments
No separate ambulatory care currently
Staff try to be accommodating
Patients always seem able to “pop up to the day ward to get tests done – they’ll do it for me”!
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8. Outpatient appointments
Mixed clinics
Busy
Staff think this is the least satisfactory part of care – not just for TYA patients
Patients don’t like the waiting
They do like continuity of care
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9. Telephone clinics / contact by ‘phone
Starting these 2 telephone:1 attended clinic (not just TYA)
Lots of telephone contact regarding blood test results, chasing non-attendances etc
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10. Access to trials Disease specific from 18 years usually
Where trials exist, offer entry – germ cell cancers, renal cancers
Started Brightlight
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11. Acutely ill / palliative care
Sudden deterioration
ITU links
Palliative care after a number of treatments
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12. Case vignettes (1) N Mediastinal GCT Urgent treatment needed
“baby” chemo followed by full chemo & surgery
Geographically not local
Family
Ward
Social worker
Lifestyle before & after
Now…
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13. Case vignette (2) P Metastatic poor prognosis testis cancer
Treated with chemo
Lived at home – Mum & brother
In trouble with the law
Completed intensive chemo + surgery x 3
Struggled to get job without address, home without a job etc
Now..
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14. Summary Acute situation v. retrospective thoughts
Whether treatment is outpatient alone or involves inpatient / day care
Aims of treatment – curative / palliative
Lack of social worker is a problem
Looking back, links with TYA team have increased over the last few years
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15. Thoughts?
Comments?
Suggestions?
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