Samantha's story

About Samantha

Samantha Thompson, CNS at Belfast Health and Social Care Trusts, tells us how CNSs deliver support, treatment and care to men with prostate cancer alongside delivering support for patients with other cancers. She also highlights the key challenges their department faces.

The situation

Samantha’s team:

• Three Band 7 Uro-oncology CNSs
• Two surgical directorates (also cover bladder, kidney, testicular and penile)
• One oncology (also covers bladder)

Our referral process

Samantha said “All our referrals are triaged by urology consultants and seen at Prostate Assessment Clinic where decisions are made for pre-biopsy MRI or straight to biopsy. Our clinic is consultant-led with our surgical CNS in other clinics who can see patients on request, for example those given a clinical diagnosis, usually advanced prostate cancer. The Consultant or Specialist Registrar (SPR) carries out biopsies.”

Diagnosing patients

Samantha said  “Our patients will attend the ‘results clinic’, about 3-4 weeks later depending on capacity. This is a joint clinic with the consultant and surgical CNS.

“Men are given a pack with written information and direct line contact number for a surgical CNS. There are four of these clinics a week with each of our surgical CNSs covering two each. Unfortunately, there isn’t capacity to see men after their appointment, as it means we miss the next patient coming in, however we regularly phone patients later (usually on our lunch break).

Treating our patients

Samantha said  “For men who decide on radiotherapy, we refer to oncology and they meet the oncology CNS, who takes over as the man’s point of contact along with a specialist radiographer.

 “Our RARP patients stay under surgical CNS care (one CNS deals with all robotic pre-and post-op care) and are seen next at a joint CNS and physio clinic to be given more in-depth info about upcoming surgery and be taught pelvic floor exercises on a one-to-one basis.

“Robotic surgery is newly available in Belfast so peri-operatively our role as a CNS is to ensure the patient’s journey runs smoothly as well as supporting staff in training.

Supporting men

Samantha said “Post-RARP, our surgical CNS will see patients for between 1 to 1½ hours. Their catheter will be removed and the CNS will give the man information about what is going to happen next and carry out a Holistic Needs Assessment. At this point, the men are drained emotionally and physically, so as a CNS, it’s important to be there for support and reassurance.

“After surgery, our surgical CNS team run clinics for erectile dysfunction treatments - vacuum pump and intracavernosal injections.

“Our Surgical CNSs also run four outpatient review clinics a week. Men on active surveillance, watchful waiting, hormone therapy and post-surgery are reviewed. Bladder and kidney patients are also reviewed at these clinics.

“The oncology CNS attends two new patient clinics, but there are several more, which they don’t have the capacity to attend. The oncology CNS also carries out nurse led reviews both at clinic and by telephone for men who have had radiotherapy, she also attends a chemotherapy-prescribing clinic.

“An oncology nurse practitioner carries out some of the post treatment reviews with research nurses who see patients entering clinical trials.”

Our challenges

Samantha said  “Our service is really reliant on each member of the team. Currently, if one of our team is off work, there is no back up. One of the surgical CNS team is also nearing retirement. Succession planning is going to be essential to make sure the service can continue to run.

Alongside supporting and treating men with prostate cancer, we also have other patients to treat - bladder, kidney and penile cancer patients.”