1. The Strategic Cancer Network (SCN) Head and Neck Cancer Pathway: Who, What, When, Where and How? Julie Hoole MHSc, BSc(Hons), NMP Masters, RGN,DN, INLPTA. Lead Macmillan Head and Neck Cancer Nurse Specialist/Project Manager

2. SCN Head and Neck Cancer Pathway!

3. 62 & 31 day Pathway

4. Who -Team approach -1 day  Primary Care Assessment –GPs and GDPs to follow the DoH ‘Referral for Suspected Cancer’ guidelines. (If GDP has no access to fax – to send urgent letter or telephone call) –Urgent suspected letter upgraded if suggested in the clinical letter.

5. Day 0-Referral  Referral assessment –Urgent Suspect Cancer (USC) with a suspicion of head and neck cancer received by the Trust. Patients contacted within 24hrs and offered an appointment within 14 days. –Maxillofacial or ENT designated clinics indicated on referral proforma

6. Preparing the patient Why you are referring them

7.  Your General Practitioner (GP) or General Dental Practitioner (GDP) has referred you to the Head and Neck Specialist team on an urgent two-week-wait appointment.  You will receive an appointment asking you to come and see one of the Head and Neck Doctors in the outpatients clinics which are held at Pinderfields Hospital, Pontefract or Dewsbury hospitals. You may like to take a family member or friend with you to help you to remember the information given.  This is because the symptoms you have described could possibly be caused by cancer – this does not necessarily mean you do have cancer. In fact the majority of patients we see do not but it is important that you are seen and assessed quickly at the hospital.

8. Bad news is always, however, in the “Eye of the beholder,"

9. What does fast track mean? The Clock Starts Every new patient is treated as having a cancer until proven otherwise

10. 62 & 31 day Pathway 7 38

11. Oncology Clinic First Visit-What happens?

12.  Examination  Biopsy / FNA 7days –Future-Core Biopsy neck lump  Book MRI and CT scans 10 days  Available –Specialist nurse –Dietician –Speech and language therapist –Wellbeing alcohol specialist nurse/detox planning………

13. Midyorkshire head and neck audit newly diagnosed cancer patients 62% What about those that were benign disease? They have not been asked this question? Did not know what to expect -1st visit

14. Who is responsible? 1. Referrer  Preparation Consent  Preparation Hospital Trust/team receiving the referral  Leaflet ‘Cancer’

15. Preparing the patient and yourself

16. Obstacles to breaking bad news

17.  Fear of causing pain  Fear of own emotions  Fear of being blamed  Fear of doing badly – the untaught  Fear of the patients reactions  Fear of damaging the patient or making things worse  Fear of having to admit “I don’t know”  Fear of illness/death of self

18. Distancing Techniques

19.  Normalising  Premature reassurance/False reassurance  Passing the buck  Switching the subject  Jollying along  Closed questions  Selective attention

20. "There is nothing so easy to learn as experience and nothing so hard to apply." (Josh Billings)Josh Billings

21. “Don't let what you cannot do interfere with what you can do.” (John Wooden)

22.  Macmillan’s own research reveals that the number of people living with cancer diagnosis in the UK today is 2 million. That number is set to double to 4 million by 2030. Cancer patients are living longer after their diagnosis than they did 30 years ago, cancer is increasingly about living with cancer with many people experiencing issues which require support several years after initial diagnosis and treatment.’ Macmillan,2013

23. Multi professional Approach

24. Thank you