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TYA Designated Hospital perspective

TYA Designated Hospital perspective. Wendy Ansell Macmillan Urology CNS Barts Hospital. Background. Uro-oncology – specialist team for testicular & other germ cell cancers Haem-onc specialist teams Gynae cancers Breast cancers Others – e.g. ophthalmology. Structure of discussion.

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TYA Designated Hospital perspective

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

  2. TYA meeting 29-10-13 Background • Uro-oncology – specialist team for testicular & other germ cell cancers • Haem-onc specialist teams • Gynae cancers • Breast cancers • Others – e.g. ophthalmology

  3. TYA meeting 29-10-13 Structure of discussion • Diagnosis • Time to treatment • Inpatient – ward environments • Day care treatments • Outpatient appointments • Telephone clinics • Access to trials • Palliative care

  4. TYA meeting 29-10-13 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

  5. TYA meeting 29-10-13 Inpatient care (1) • Staff opinions • Nursing • AHP’s • Medical • Other e.g. psychologists • Environment • Facilities • Computer access • Wi-fi

  6. TYA meeting 29-10-13 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

  7. TYA meeting 29-10-13 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”!

  8. TYA meeting 29-10-13 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

  9. TYA meeting 29-10-13 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

  10. TYA meeting 29-10-13 Access to trials • Disease specific from 18 years usually • Where trials exist, offer entry – germ cell cancers, renal cancers • Started Brightlight

  11. TYA meeting 29-10-13 Acutely ill / palliative care • Sudden deterioration • ITU links • Palliative care after a number of treatments

  12. TYA meeting 29-10-13 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…

  13. TYA meeting 29-10-13 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..

  14. TYA meeting 29-10-13 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

  15. TYA meeting 29-10-13 Thoughts? Comments? • Suggestions?

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