Supporting Londoners affected by cancer

Dr Philippa Hyman, Macmillan Mental Health Clinical Lead for our Transforming Cancer Services team, writes about how we’re working to improve psychological support for people affected by cancer.

One in two people will be diagnosed with cancer at some point in their lives.

Earlier diagnosis and improved treatment means more Londoners are now surviving cancer and living with the consequences of cancer and its treatment.

In 2013, there were around 223,500 Londoners who were living with cancer or had survived it. That’s enough people to fill Wembley Stadium two and a half times.

We know that around three quarters of people affected by cancer need access to psychological and emotional support.

In the year following diagnosis one in 10 people experience symptoms of anxiety or depression that require support from specialist services.

The roller coaster of having to make choices around treatment options and then coping with treatment such as surgery and chemotherapy is not something anyone is prepared for.

It’s also important to remember that the emotional effects of cancer don’t just end when the treatment does.

People often say they feel more lost and worried when their treatment is over.

They are living with the enormity of what has happened long after the cancer has been treated and the specialists have done their job.

They often fear that the disease will return or have to deal with the long term effects their treatment may have caused.

This can include changes in appearance, chronic pain, altered abilities or limited mobility, body image and relationship problems, difficulties working and financial worries too.

Making sure people affected by cancer can access psychological support if they need it is one of the key areas of work for Healthy London Partnership’s Transforming Cancer Services Team (TCST).

In June 2015, we worked in partnership with the London Mental Health Strategic Clinical Network to publish guidance to support CCGs and service providers to improve psychological support for people affected by cancer

Psychological support for people living with cancer — Commissioning guidance for cancer care in London outlined 10 recommendations which covered commissioning, workforce education, training and supervision, and service development and delivery.

The report outlined the importance of improving access and provision of psychological support, and highlighted the variation that exists across services and examples of best practice.

With support from Macmillan, we’re now building on this guidance to develop a pathway and service specification for London. This will provide commissioners with detailed guidelines for what excellent psychological support should look like for people affected by cancer in London. This will include support before diagnosis, after diagnosis, during cancer treatment as well as what is needed after treatment ends.

We are also looking at what support should look like for people who are receiving end of life care, and for those who may have emotional needs months or years after the end of their cancer treatment.

On Thursday 4 May we held an event to bring together patient representatives, service providers and commissioners to discuss what an excellent psychological care pathway for people affected by cancer should look like.

We presented our draft pathway for psychological support and looked at what works well in London, what is missing and how support can be improved for patients.

Ideas and feedback from this event will be incorporated into the final pathway, with further conversations also due to take place with patient representatives and stakeholders. Another event to present the final pathway will also take place later in the year.

Being diagnosed with cancer is life changing.

Many people describe it as being a bit like ‘falling off a cliff’.

Most people find ways to cope using a variety of their own resources such as support from family, friends or the voluntary sector, for example Macmillan Cancer Support.

But for those that need it, the consequences of not providing psychological support are far reaching.

Many people tell us that they find the emotional effects of cancer and its treatment more difficult to cope with than any physical or practical effects.

Psychological care is the responsibility of everyone who comes into contact with someone with cancer.

We need to make sure that everyone affected by cancer now and in the future has the support they need to cope with the impact that it has on their mental health.

The views of patients, families and carers will continue to be an essential part of this project to make sure we get this right.

We want to ensure that all Londoners can get the right support, at the right time and in the right place.

About the author

Philippa has been a clinical psychologist working in the NHS since 1999. She was Head of Older Adults Psychology in Tower Hamlets between 2006 and 2013. She has worked to support with people with mental health and physical health difficulties in both primary and secondary care services.

For more information about the work of the Transforming Cancer Services Team please email England.TCSTLondon@nhs.net

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