Beverley Anderson

Cancer management: the difficulties of a target-driven healthcare system

This article gives a reflective overview on cancer management from a urological perspective. It is based on anecdotal evidence and observations of local practice, and highlights some of the inherent difficulties of delivering a robust service in a target-driven healthcare system. Cancer is a complex disease. It is crucial that stringent measures are used to ensure those affected by it receive care that is of the highest quality, delivered in a timely manner, and tailored to meet the individuals needs. In 2000, the Governments attempt to increase competition among healthcare providers in the delivery of care, and thereby healthcare quality and efficiency, resulted in a number of healthcare reforms being introduced in the UK. Central to these were the NHS Cancer Waiting Time standards, which were designed to fast-track care delivery in the management of cancer patients. The multidisciplinary teams play a pivotal role in this process and their contribution is imperative to achieving the desired outcomes. It is acknowledged that targets can be beneficial, but there are clear unintended consequences as well. Increases in urgent referrals result in significant screening demands and, consequently, newly diagnosed cancers. This, combined with factors such as patient choice and costs, put added pressure on NHS establishments and health professionals to deliver care within the target specifications.

Bladder cancer: overview and management. Part 2: muscle-invasive and metastatic bladder cancer

This is Part 2 of an article on bladder cancer: an overview of disease and its management. Part 1 provided an overview of non-muscle-invasive bladder cancer, how the disease presents, is diagnosed and subsequently treated ( Anderson, 2018 ). Part 2 provides an overview of muscle-invasive and metastatic bladder cancer and outlines treatment options currently available to manage the relevant stages of the disease. The management of muscle-invasive cancers comprise surgical intervention with transurethral resections, cystectomy (removal of the bladder), and systemic chemotherapy and radiotherapy (multi-modality treatment). For locally advanced and metastatic disease, systemic chemotherapy and radiotherapy are offered, but only as a palliative measure. The intent of treatments for muscle-invasive disease is curative. For metastatic disease, the intent is disease control, extending life, managing symptoms and improving quality-of-life outcomes. This article will include the treatments for the relevant stage of muscle-invasive and metastatic bladder cancer and highlight the respective risks and benefits. The risk factors for bladder cancer, such as smoking, and risks associated with relevant treatments are discussed. The role of the multidisciplinary team is underlined in the management of bladder cancer, specifically the role of the uro-oncology cancer nurse specialist in the provision of reassurance and support to patients.

An insight into the patient's response to a diagnosis of urological cancer

A cancer diagnosis and the patients response to the news pertains to all types of cancer, however, in this article, the focus is on urological cancer. Intrinsic to the management of this patient group is the urology multidisciplinary team, in which the role of the cancer nurse specialist (CNS) is pivotal. For most people, a cancer diagnosis is arguably their worst fear. It is therefore prudent that a holistic approach is used when determining care and ensuring that appropriate support is forthcoming. This necessitates an assessment of the physical, psychological/emotional, psycho-social, spiritual and cultural components of the individuals healthcare needs, and accordingly, devising a plan of care to secure the best outcomes. This article concentrates on the psychological/emotional component. It outlines a case study of a patients response to the consultants question in the joint consultation clinic, examines the CNSs interpretation and understanding of the events, and her perspective on whether factors such as fear, anxiety and distress influence the individuals response to the diagnosis, their comprehension of information and the messages relayed, and consequently, their ability to manage the ensuing issues. It also looks at the support available to cancer patients following the receipt of a cancer diagnosis and its efficacy in addressing their concerns. Integral to this is effective communication, specifically the timely provision of information by health professionals.