Addressing Fear: One Therapeutic Radiographers Approach to Proactive and Supportive Cancer Care.

My name is Fiona Sinclair and I graduated in July 2000 as a therapeutic radiographer.

I have always loved working within the radiotherapy department and from the start of my career I have had a real drive to support patients who have undergone treatment for cancer.

In 2012 I was given a new role which allowed me to be more active in supporting breast cancer patients during the course of their radiotherapy and it became apparent to me that a lot of patients were very anxious regarding the future as active treatment comes to an end.

Patients would often ask things like ‘how will I know if this treatment has worked’ and I always felt that although we are very fortunate to have such amazing scans, treatments and drugs etc we didn’t offer enough psychological and emotional support at the end of treatment.

Patients often feel out of sync with families and friends who see end of treatment as a celebration and yet they themselves report that they are often struggling more at this stage than at diagnosis.

At the end of 2016 a secondment was advertised initially for twelve months funded by Breast Cancer 2000 and the Beatson Cancer Charity to pilot a group intervention alongside a clinical psychologist. The role was to design, implement and co-facilitate a six week programme supporting breast cancer patients with the ‘what if’ worries around cancer coming back.

To me this was the perfect role and exactly what I had always set out to achieve in my career but never felt this opportunity would ever arise and therefore I applied and was appointed in January 2017.

We designed the intervention to have the following three main components.

Psychology content which is underpinned by a therapeutic model called Acceptance and Commitment Therapy (ACT), a patient education component and lastly an invaluable aspect of this intervention is the peer support.

Throughout the 3 years that the fear of recurrence project has been running data has been collected from patients and the statistics clearly show that after completing the group intervention people have less fear of recurrence, are less anxious and depressed, report a better quality of life and importantly, have the ability to live with distress.

By the end of the group patients often speak about being less preoccupied by worry, calling GP’s and CNS less often for reassurance, being more physically active, re-connecting with friends and family and getting back to doing things they enjoyed in the past. Many also find that they re-evaluate what is important to them in life and some make significant changes to things like their work-life balance.

The difference this group has made to many ladies who have attended is immeasurable and makes all the hard work worth every minute.

Like many services our face to face group programme came to a sudden halt in March 2020 with the impact of COVID-19. It was important to us that we continued this support and within six weeks we commenced our first digital group.

We miss the face to face interaction, however the positives are that patients can attend without travel, allowing us to support those living further afield and the data collected from the outcome measures are reflecting that the digital service is as effective as the face to face programme.

The feedback from this programme led me to set up a psychological prehab programme alongside a support and information radiographer in the form of a radiotherapy open evening.

This service allows patients to attend the department with a relative/friend in a safe environment where they will not be having any form of treatment or test results.

We discuss ways they can look after themselves before, during and after radiotherapy including skin care and healthy lifestyle and we sign post to other support networks.

They receive a tour of the CT planning room and radiotherapy treatment room where they can explore the machines and equipment that will be used during radiotherapy treatment and gain a full explanation with the opportunity to ask anything that may be a concern to them.

The difference these services make has not only been demonstrated by the outcome data but also from feedback that we receive from both the patients and NHS staff.

Both these services provide reassurance and empower the patients throughout the process which impacts on adherence to treatment, follow up scans as well as a reduction in added appointments and phone calls to their CNS and GP’s.

I genuinely feel honoured to be part of both these services, having the opportunity to be able to pass on the knowledge and information that I have gained throughout my career to alleviate patient’s worries and make the process of treatment and beyond easier – for me is the best job I could ask for.

We are very grateful for the continued support that we have received from Breast Cancer 2000 and the Beatson Cancer Charity as without that them these services would not be possible.

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