GP Masterclass A Case Study Catherine Dale, RN, BSc Cancer Care

1. GP Masterclass A Case Study Catherine Dale, RN, BSc Cancer Care Macmillan Advanced Nurse Practitioner, Uro-Oncology Heatherwood and Wexham Park NHS Foundation Trust

2. What am I talking about? • Outline and discuss the care of a patient with prostate cancer from first GP appointment • Highlight key events in the patients cancer journey in secondary care • Identify key points of ANP contact and intervention with the patient and family • Identify key points of GP/ANP communication • Highlight the key role the ANP has between primary and secondary care

3. LUTS Male Patient Aged 55 Presents to GP with........ DRE nodule left lobe PSA 30 Afro Caribbean Family history prostate cancer Suspected Cancer Referral to local Urology MDT

4. Appointment with Urologist and ANP MRI Pelvis - neg Bone Scan - neg TRUS and Biopsy Shows Gleason 4+4=8 adenocarcioma of prostate Local and Specialist MDT discussion Multi-modality treatment Breaking bad news and decision making Over a couple of weeks Joint Clinic Urologist, Oncologist & ANP Issue prescription charge exemption certificate Complete holistic assessment of patient & care plan Inform GP of diagnosis via fax by end of next working day Issue information prescription The ANP will.......................

5. Radical Prostatectomy Supersensitive PSA rise OPA with Oncologist & ANP Plan for prostate bed radiotherapy Supersensitive PSA rise commenced on maximum androgen blockade Discharged for PSA monitoring aware will need to be referred when PSA rising Review patient on ward and fax a copy of patient End of Treatment Summary to GP Support patient and make MDT referrals for ED & urinary incontinence Complete further information prescriptions on treatment and side effects Complete further holistic assessments and care plan The ANP will.......................

6. Supersensitive PSA rise GP refers back to oncology Oncologist & ANP appointment. Re-staging scans show bone mets Patients commences six cycles of Docetaxol chemotherapy - Response then Supersensitive PSA rise Offered second line chemo but refused as feeling too unwell Patients commences Abiraterone – Response then supersensitive PSA rise Monitor patient in nurse led outpatient clinic Issue DS1500 certificate and assist patient to apply for this palliative benefit Liaise with GP & hospital consultants to manage general palliative symptoms Holistic assessment and information prescription The ANP will.......................

7. Patient now has uncontrolled cancer disease • blood transfusion dependant • Anorexia and weight loss • Night sweats • Bone pain • Only cancer control treatment low dose steroid Support family in the transfer of care back to the community Liaise with GP and DN to transfer care to primary care Refer to community palliative care team for specialist palliative care The ANP will.......................

8. LIAISON LINK BETWEEN HOSPITAL AND PRIMARY CARE Advanced Nurse Practitioner EXPERT CLINICAL ADVICE SUPPORT FOR PATIENT MAIN POINT OF CONTACT

9. Thank you! Any Questions?