Funded by us, Lucy Baker works as a Specialist Prostate Cancer Palliative Care Nurse at Northamptonshire Healthcare NHS Foundation Trust, supporting men in their final year of life. Here she describes how her role helped three men deal with the pain, anxiety and immobility of their disease, and the vital link she provides between patients at home and health professionals in the clinic and hospice.
I’d visited Geoffrey at home on several occasions to support him with prostate and gastrointestinal cancer and make changes to his painkillers.
His consultant had requested a number of blood tests, including a PSA test, a few days prior to our meeting. The PSA had come back elevated but he wasn’t due to see his urologist for another two months. His hormone treatment was no longer controlling his prostate cancer either.
My early intervention helped Geoffrey avoid being admitted to hospital
I was able to quickly report back his PSA result to his uro-oncology nurse, who spoke with his urologist the same day. His follow up appointment was then brought forward, and I reviewed and changed his hormone medication at home prior to his appointment with the consultant.
As a generalist palliative care nurse, I would not have had the specialist knowledge around treatment therapies and the PSA to do any of this. My early intervention helped Geoffrey manage his symptoms and may have avoided him being admitted to hospital.
Jonathan was referred to me with a weak leg and deteriorating health, after being discharged from hospital with advanced prostate cancer in his bones, lungs and liver that was no longer responsive to hormone treatment.
I visited him at home to assess his pain needs and to discuss his anxieties. Although Jonathan’s pain levels were manageable, his mood was very low and it was his reduced mobility caused by lymphoedema in his left leg that most concerned him.
Without my in-depth assessment, I might easily have assumed Jonathan’s low mood was solely down to his poor prognosis
Having always been an active man, he found it frustrating sitting for long periods because the leg felt so tight and heavy. He felt he had lost control and the quality of life had palled. Without my in-depth assessment and honest conversation with him, I might easily have assumed Jonathan’s low mood was solely down to his poor prognosis.
As it was, I was able to refer him promptly on to the hospice’s lymphoedema service, where he was assessed and his wife was taught massage techniques to improve the tightness in his leg. His mood improved and he felt back in control of his symptoms, allowing him some quality of life in the short time he had left.
When I spoke to Peter over the telephone about managing his pain, he was clearly a very anxious person who had never had any other illness until his diagnosis of prostate cancer a few years earlier.
He had been managing the disease well with hormones, but now the cancer had become hormone resistant and he’d been referred to the oncology doctor for chemotherapy. Despite my advice to increase his oral morphine, he was still experiencing pain intermittently throughout the day, so I invited him to the hospice to meet with me face to face.
Through assessing Peter’s needs holistically, I was able to help him overcome some of his fears about his symptoms
Peter was very anxious when he arrived and visibly shaking. We spent 90 minutes discussing his fears and concerns and it was clear that his psychological state was impacting on his pain. By the end of our appointment, Peter seemed more relaxed and I arranged for him to take the anti-anxiety drug, Lorazepam. I also gave him advice and information booklets on chemotherapy and what to expect.
The following week, Peter was feeling a lot more comfortable, his pain had eased and he found the Lorazepam very helpful. Through assessing Peter’s needs holistically, I was able to help him overcome some of his fears about his symptoms and how they can impact on one another.
Lucy is funded as part of our Health and Social Care Professional programme to improve care pathways for men with prostate cancer. After initial set up, we work with all projects to secure on-going funding from their Clinical Commissioning Group and local authorities.
(All patient names have been changed to protect their identities.)