In this, Kidney Cancer Awareness Week, we are please to offer this snapshot into a day in the life of a CNS at London’s St Bart’s. We are so grateful to Daniel for taking the time to write this blog.
My name is Daniel Richardson and I’m a new uro-oncology clinical nurse specialist (CNS) working at St Bartholomew’s Hospital. Previously, I worked at the Royal Marsden, London in the urology ward. I have moved into a CNS role with the amazing team at St Bart’s alongside Shievon Smith (CNS), Michelle Greenwood (CNS) and Emily Wilson, our Macmillan Navigator.
Below, if there is such a thing, is a typical Tuesday for me…….
Tuesday: 08:00 – 10:00:
Urology MDT – Every Tuesday I attend the urology multidisciplinary team meeting (MDT) which comprises a team of consultants from medical oncology, clinical oncology and surgical, radiographers, pathologists, specialist nurses and a MDT navigator. The aim of the MDT is to ensure the patient receives the best possible care on the correct pathway. These patients are on a cancer waiting target of 31 days for diagnosis and 62 days for completion of treatment (with the exception of testicular cancer which is 31 days to complete curative treatment).
During this meeting we discuss a large caseloads round 70 cases (often 20 pages full) of patients with suspected urological cancers from all of the Bart’s hospitals (Whipp’s Cross, Newham, St Bartholomew’s, Mile End and The Royal London Hospital), we also discuss cases from Homerton presented by one of their urologists who attends our joint oncology clinic at St Bart’s. The MDT reviews radiology, histology, and any general queries relating to their treatment or diagnosis, with the CNS team advocating on behalf the patients, as generally CNS’s spend the most time getting to know the patient and their care needs as part of a holistic needs assessment (HNA). The MDT makes the ongoing treatment plan which on occasion, might include referral to another team. For example there was a patient in today’s meeting with suspected kidney cancer. His consultant added this patient onto the MDT so that the radiology could be reviewed to identify if this was a suspicious lesion which required biopsy or a cyst. The patients recent CT scan unfortunately revealed a 2.5cm lesion in the upper pole of the left kidney, as well as a large mass in the right upper lobe on the patients chest. This case was discussed in the MDT and it was felt that this patient should be referred to the lung MDT and the surgical cancer centre for 2 synchronous primary’s.
Dr Shamash’s clinic – After MDT I join Dr Shamash’s clinic which has started at 0900 with the junior doctors and CNS’s running their clinic lists. This clinic reviews patients with testicular cancer and a few metastatic prostate cancer patients (our normal prostate day is Thursday). Again I perform holistic needs assessments, offer support for those receiving bad news and signpost patients to Maggie’s Centres and Macmillan for further support, alongside support groups run by us, the CNS teams. At this time I will issue the key-worker contacts for myself and the team, so patients can call or email with questions which they might not have had time to consider at diagnosis.
Prof Powles clinic – I grab a quick drink and eat my lunch before attending Prof Powles clinic where I see patients with metastatic kidney and metastatic bladder cancers. In this clinic we meet new patients referred to Prof Powles and take the time to perform a HNA to assess the physical, social and psychological concerns that the patients have. These patients are signposted to Kidney Cancer UK, or Fight Bladder Cancer UK along with the other charities. Kidney Cancer UK offer emotional support via telephone counselling and grants on a case by case bases, which is a great support for our patients. I conduct first cycle counselling for any patients starting treatment taken at home.
The following day:
Wednesday I am based in the office catching up on the paperwork, referrals and jobs from the previous day in the clinic. This can include palliative care referrals, district nurse referrals, checking blood results, audiology referrals, requesting treatment (chemotherapy, immunotherapy to be booked etc. The ‘yellow pages’ in the photo are consent forms which all need to be checked, scanned to the chemotherapy schedulers to request a booking date, and scanned onto the patient record. We also scan the yellow consent form for TKI’s, which we undertake first cycle counselling with the patient. At this time we issue a pharmaceutical pack, re-issue our key-worker contact details and hotline card for emergencies. Also hidden in this photo behind a very confidential white box is our phone book, where patients contact us with any concerns or questions surrounding their cancer diagnosis and treatment. Cancer services are still very busy here at St Bart’s, but all of us here are very happy and proud to support our wonderful patients.
This is a very brief insight into a day in the life of a CNS. No two days are the same but that’s what keeps the job exciting!
Uro-Oncology Clinical Nurse Specialist
2nd February 2021