Video transcription

Innovations in Surgery Part A

The Head & Neck Cancer Innovations 2020 Video Series is brought to you by St Vincent’s Hospital Sydney & The Kinghorn Cancer Centre. In this episode we talk to head & neck surgeon A/Prof Richard Gallagher about innovations in surgery for head & neck cancer patients. For more information please visit our website or our You Tube channel. The podcast versions can be found on our SoundCloud channel.

Hans Ede, Head & Neck Cancer Survivor
Julie McCrossin, Head & Neck Cancer Survivor
A/Prof Richard Gallagher, ENT Surgeon, St Vincent’s Health Network Sydney

Julie McCrossin
Hello, my name is Julie McCrossin and it gives me great pleasure to welcome you to this video on innovations in surgery. That is part of a series of videos that’s all about treatments and care to improve the survival and quality of life of people with head and neck cancer.

And these videos are hosted by St Vincent’s Hospital Sydney and the Kinghorn Cancer Center. And in fact, we’re in an operating theatre right now inside St Vincent’s Hospital. My name is Julie McCrossin, and I’m a survivor of head and neck cancer. Seven years ago, I was treated for stage four oropharyngeal cancer in my tonsils, tongue and throat. I only had a biopsy, my treatment was radiation and chemo.

And I want to acknowledge, before we begin our conversations with some clinical peeps I’ve got waiting – and we’ve got a surgeon, a very experienced nurse coordinator and also a very experienced speech pathologist – to talk about the changes in care and treatment that are trying to reduce the side effects and keep us alive longer and better.

But before I begin, I want to acknowledge that we’re broadcasting to you today on Aboriginal land. This is the land of the Gadigal people of the Eora nation. And I want to pay my respects to Elders past and present and emerging leaders and most significantly to acknowledge that Aboriginal people and some Torres Strait Islander people are disproportionately affected by the cancers that we’re talking about in this series.

So, just before we meet the clinical peeps, I’d like to introduce a short comment and question from Hans Ede, who’s a head and neck cancer patient who’s had a lot of treatment.

Hans Ede
Hi, I’m Hans Ede from Camden, south of Sydney. In 2011 and 2013, I had surgeries and extensive radiations to my throat. To all the surgeons and oncologists and nurses, to you, I’m forever grateful and thank you for saving my life and making me a survivor beyond five. But three years ago my body started to break up and I had problems.

So my question to the panelists, is there such a thing today, or is it any plans to introduce a multidisciplinary team for after the treatment for patients with complications, to help them to have quality of life, not just to survive, but the quality of life is important? And I would hope, if that’s the case, we can go from instead of being beyond five to beyond 10? Thank you.

Julie McCrossin
So that was Hans Ede. And I know he speaks for many survivors of head and neck cancer who was so glad to be alive. But many of us are dealing with some quite significant side effects. Many of them reduced, but for some people they do continue to be part of our lives. And so this series is all about what can we do to either reduce those side effects or functional changes, or indeed, to live with them more effectively.

So it gives me great pleasure now to introduce our first person on the innovations in surgery video. Richard, can you introduce yourself to the audience and explain for people who’ve never seen a room like this what you do?

Richard Gallagher
I’m a ENT head and neck surgeon. So I’ve trained in looking after patients with head and neck cancer, really. I look after anything that any of the cancers that involve you from above the clavicle, so above the shoulders upwards, and I’ve been working here for about, I initially started training in 1991, but I’ve been working here for 22 years.

So I’ve got a lot of experience. And really all I do these days is look after patients with head and neck cancer. You’re standing in, we’re standing in the operating room. And in fact, this is the operating room that we have our friend, the Da Vinci Robot, here, which is one of those really important innovations which has come along to help us in head neck surgery. And really, to be honest, it’s about helping the patients and things that are going to make life better for patients.

Julie McCrossin
And I know that many of our patients and also clinical team members watching are keen to hear about the robot. But before I do that, can you just give us a sense of the range of surgery you’ve done over the years? So we get a sense, because not everybody is eligible for that robot. So what is the range of surgery you have done and still do for people with head neck cancer?

Richard Gallagher
So I think one of the things about head neck cancer is that, a couple of things, I think head and neck cancer patients get a raw deal. Basically, how they’re looked after in general across Australia and New Zealand. And I think that, that it can be done better.

And I think they can be better supported by government and better supported by the health departments and the jurisdictions and different people who are actually contributing to looking after patients.

But as part of that, it’s important that we be able to provide all different types of surgery for the head neck. Because the problem with head neck cancer is that we’re talking about multiple different cancers, which make up the head neck cancer group.

But individually, some of those cancers are a tiny number of cases. So if you’ve got a cancer of the sinus, you’re in fact one of only a small number of people who have cancers of the sinus. And if you have a cancer of the larynx these days, you’re actually a small number of patients. Whereas there used to be lots of patients when there was lots of smoking going on. There’s much less now.

And conversely. So we’re seeing lots of patients because of, I suppose really, an epidemic of oropharyngeal cancer. So we’re seeing those numbers increasing.

So for me, I look after a range of cancers that go from laryngeal cancer, so cancers of the voice box, through to the cancers of the sinuses, and the nose and the septum. So the centre part of the nose, the back of the nose, the mouth, the throat, cancers of the skin. So the whole gamut of different types of cancers, which might make up head neck cancers, but you can see that each of them is actually a small group that contribute.

And so it’s different to other cancers which get a lot of publicity, which are things like breast cancer and prostate cancer, because you’re talking about one thing, whereas we’re talking about lots of lots of different cancers.

Julie McCrossin
Before I turn to the technical innovation of the robot, the Trans Oral Robotic Surgery, which I think makes up the bulk of your work now.

Richard Gallagher

Julie McCrossin
How significant has the development of multidisciplinary teams been in giving the head and neck cancer patients a better deal? Because you began with a very strong statement that we get a bad deal. So obviously, I want to know how. But most importantly, what are the innovations? What are the changes that are improving the deal we get?

Richard Gallagher
The original multidisciplinary teams were all built around head and neck cancer. And I think the reason for that is that… and I think Hans, who we heard from earlier represented that group of patients …who we affect and we deal with those really important things in life.

You can’t hide what we do under your clothes. You know, we affect your speech, your swallowing, your physical appearance, how you appear to the world, how you feel about yourself, you know, you’ve got to look in your look in the mirror each day, and you’re the one who has to look at yourself.

The multidisciplinary team becomes really important in that. Now we were talking before about what sort of things that we might do. And the sort of surgery that I’m most interested in is surgery that’s going to preserve function for patients. But to do that, and to do those operations that you can preserve function, you need a whole team approach.

So it can’t just be about the technical expertise of the surgeon. You’ve got to have that expertise, but you need the support. So for instance, we’re talking about laryngeal cancer. So I’ve always done a lot of what we call partial laryngeal surgery.

Julie McCrossin
And explain again “laryngeal”, that word for people.

Richard Gallagher
So cancer of the voice box. So typically, if someone has a bad cancer of the voice box, they might get offered radiotherapy, or they might get offered to have the whole of the voice box removed.

But there are some surgeons around who are well trained in doing what we call partial laryngeal surgery. And whether that be down through the mouth using a laser, potentially using the robot here, or doing an operation from the outside, but the aim of that is to preserve someone’s function so they can preserve their speech and their swallowing.

So to do that, though, you need the team.

Julie McCrossin
So explain. Give us an example of key team members from your point of view as a surgeon.

Richard Gallagher
So the key team members become the speech therapists, right, who are going to be involved with rehabilitation of swallowing and speech after surgery.

The dietitians, because it’s important that patients maintain their weight during treatment. It’s one of the really sad things and the bad things that we see as we see patients losing weight. Sometimes people think that’s a good thing, but it’s not really a good thing when you’re having cancer treatment, unfortunately.

And then there are other members, there’s the physiotherapists who are involved.

Julie McCrossin
Yes, explain the physiotherapists. What do they do?

Richard Gallagher
Physiotherapist, particularly for head and neck cancer where you’ve got to do operations on the neck, where you might injure or cause problems with function of the shoulder, physiotherapists are really important with that rehabilitation. Yes, physiotherapists, a lot of the ones who do head and neck are interested in other areas, such as lymphedema treatment, so they help with treating lymphedema.

Julie McCrossin
Explaining what that is?

Richard Gallagher
So lymphedema is swelling that patients will often get after treatment. It can be particularly bad if you’ve had a combination of surgery and radiotherapy. But you can get it alone if you just have radiotherapy. But it’s where you might get swelling of the neck.

It’s a bit unpredictable. It might be there in the morning when you wake up and you feel quite swollen. And in fact you get swelling inside your throat from the radiotherapy treatment. And during the day, because you’re standing upright and gravity makes fluid move down your body, that will go away.

But some people, it goes up and down all day and it really bugs them. And they feel tired in the neck, swollen. And so lymphedema therapy is aimed at trying to reduce that and trying to encourage the flow of lymph fluids – so that’s that clear fluid that travels through your tissue, that’s unfortunately what cancer cells go through to get to lymph nodes – but it’s to encourage a way of the lymphedema fluid or the fluid going elsewhere.

Julie McCrossin
I’m sorry, Richard, I interrupted you earlier and you were running through the team. Can you just explain who else is in that team and how it works? And is it fair to call it an innovation that is improving survival and quality of life?

Richard Gallagher
First of all, the team itself is a wide group of people. So it’s doctors. It’s medically trained people, whether they be nurses, cancer care coordinators and the allied health team who are really important.

So that allied health team, which combines speech therapists, it’s our social workers, our dietitians, our psychologists, our physiotherapists, even people like occupational therapists come into play. They may not meet with us all, but they’re important in your journey through your treatment.

And then there’s the doctors who are involved. So there’s the surgeons, radiation oncologists, medical oncologists, dentists, and our all of trainees and other people who are learning about how to treat patients with head and neck cancer.

So, is this seen as an innovation? It is, really. I mean, head and neck cancer was the original multidisciplinary team. Multidisciplinary teams really were built around head and neck cancer.

Julie McCrossin
And is that because it’s such a difficult cancer and it has such a harsh impact on many of us?

Richard Gallagher
Absolutely. So the reason is because it just affects you so much. So it affects your speech, your swallowing, your appearance, and all of those things and all of those things.

You know, as a surgeon, I can’t look after all of that. I have lots of patients where I help look after that, and I coordinate their care, but what we’re doing is we really need those key people involved.

The speech therapist looking after your swallowing and the speech. The dietitian. The clinical psychologist, you know, not everybody needs to see a clinical psychologist, but if you do, and you’re down, and you need help, you need to see them.

Julie McCrossin
As I understand it, if I’m a patient right at the beginning of my journey, from what you’re saying, I need to be with a multidisciplinary team. And I’ve also heard that if your doctors see a lot of patients, and do a lot of the same work, that makes me safer.

What is the level of access to multidisciplinary teams with experienced doctors? And is it different for public and private because sometimes, to be honest with you, I feel that private patients don’t necessarily get the same access to the multidisciplinary allied health team. But that may be incorrect?

Richard Gallagher
You’ve touched on a whole lot of really important areas. I think one of the one of the number one things is, it’s about the volume of patients being treated. So if you have a cancer of any type, whether it be head neck cancer or other types of cancer, right, you really need ideally to be treated in a centre that treats a lot of patients. All right.

And I think that’s one of the things about access to multidisciplinary teams. One of the problems – and I was saying that we get a raw deal in Australia – is geographically we are widely spread. Economically, we’ve got people of different economic status throughout society.

And it’s really important that we’re trying to bring all those people together. So it shouldn’t matter where you live, and it shouldn’t matter what your what your status is.

Julie McCrossin
It shouldn’t, but does it?

Richard Gallagher
Well it does.

Julie McCrossin
Just bluntly, what difference does it make? What are the things we still need to improve?

Richard Gallagher
We need to improve things for patients from the regions, particularly, and certain parts of the larger metropolitan area who get left behind. And those people need to be lifted up, and they need to be brought in and looked after.

So I think one of the things that we see is that we see that patients will often get treated at centres where they don’t really have much experience. And that’s a real problem. And it’s a real problem for regional patients.

I know that it’s ideal if people have treatment close to home. And you know, for a lot of cancers, which are very common cancers, that’s a good thing. And you can do that.

But for hidden neck cancer, really it’s not necessarily ideal. Some cancers can be looked after there, but a lot really, if they’re highly specialized, need to be brought into bigger areas.

So that makes a difference. Look, it improves care. It improves long-term survival. And it improves how you get looked after in the long term down the track.

Julie McCrossin
We’ll look just before I get to the robot, because I know some people will be watching this and saying for goodness sake, Julie asked him about the robot.

I just want to … I’m mindful of Hans Ede, whom we saw at the beginning. And I, you’ve given a marvelous summary of why a multidisciplinary team is extremely helpful.

But has he got a point, that we need as patients, particularly those who’ve got prolonged side effects or prolonged functional difficulties – you meet people who’ve had surgery who have trouble opening their mouths, they have ongoing surgical needs, and they may, due to necrosis or bone death from radiation, need to have even new jaws put in it. You know, there’s many things that happen.

If I come back in five years and interview you again, will we have, across Australia and New Zealand, long-term multidisciplinary team rehabilitation for head and neck cancer patients?

Richard Gallagher
I think this is a really important point. And this is part of saying that, you know, when I made that comment about head and neck patients get a raw deal. I think that this is one of the areas that needs to be improved, and that really needs to be worked on.

It’s fine, you know, if you get prostate cancer, or you get breast cancer, you tend to find that people get looked after forever. And that the journey is a long journey that goes on forever.

And it’s the same for head neck patients. It’s just the same journey. And it’s a long journey. And hopefully it is a long journey for people, rather than a short journey. But It’s important that we help people beyond five years and longer because, particularly with the HPV epidemic, you know, patients are surviving longer.

And we know that if you get radiotherapy, right, and we know that if you get a combination of radiotherapy, and well, certainly, if you get radiotherapy alone, and you were in a group of patients who were treated many years ago, that you will have got very high dose radiotherapy in combination with chemotherapy.

And the problem is that we know that things start to change. And they don’t change in the first five years. It starts to change after five years and at 10 years and at 15 years.

And you know, that’s when I end up having to look after a lot of patients. And I see patients who, unfortunately, need to go on and have further surgery done because they can’t swallow anymore, which is a tragic problem that happens.

So everything that we … part of the innovations in surgery is to try and stop that from happening, so we can provide another way of treating patients. So the robot is a good example because it does mean that some patients who, even if they need extra treatment with radiotherapy, they don’t get as much radiotherapy. So the risk of long term side effects is less.

But coming back to what you were talking about.

We do need to develop that idea that the multidisciplinary team is a long-term, ongoing management. And I suppose that’s where follow up is really important. So that you just don’t, you know, when you click over to five years, you don’t just become a statistic and then people wave you off into the sunset.

Julie McCrossin
Because Richard, you know, as I promoted that I was doing these interviews, I have been flooded with very specific detailed questions about a multitude of side effects and functional issues as I’ve learnt to call them. Problems with swallowing and eating and speaking, and I’m not going to read them all out now.

Why? Because some people will be watching this who’ve just been diagnosed, they may well not get many of these side effects. And I want to turn with the minutes we have left to innovations in the surgery.

But, but look, let’s turn to the robot because I know people are dying to hear about it. And you mentioned HPV, and I just want to show you this and show our audience this. This is a sort of soft plush toy of the human papillomavirus.

And in the past people like me with oropharyngeal cancer, it was in my tonsils, tongue and throat. It probably would have been heavy drinking or smoking. But I hadn’t drunk or smoked since the 1970s.

And when you told me I had cancer, I nearly fell over with shock. But I didn’t know I had the human papillomavirus and yes, I am one of the people in Australia who has had oral sex. But I gather it can happen spontaneously without this practice as well.

But explain to me, why is this virus still an issue, when our children are now getting HPV vaccine? So why will you spend your career with HPV patients?

Richard Gallagher
So HPV, is human papillomavirus, is a really common virus, and it causes all sorts of problems in the human body. But for us and the head and neck, it causes throat cancers, as you know. So cancer really at the back of the tongue. So in the tonsil tissue on the back of the tongue that people don’t realize is there and the tonsil tissue, which is on the side walls of the throat that we all know about.

But why is it such an issue for us? Because it’s tied up with sex, okay, and that’s the bottom line. Most people know a lot about HPV because they think about it to do with cervical cancer or cancer OF the vagina and cervix in women. And that’s clearly … and that’s related to sexual practice.

But as things changed during the 60s and 70s, and 80s, there are changes in sexual practice. So, you know, people would say took up oral sex, yes.

Julie McCrossin
And also anal sex.

Richard Gallagher
And anal sex. Exactly.

Julie McCrossin
You can get this in the penis from HPV.

Richard Gallagher
You get it in … you can get it in the anus. In the penis. You get it in the vagina, or any area related to the female genital tract, and in the back of the throat, in the oropharynx, at the back of the mouth.

But the the reason it’s an issue is because the virus has been around for thousands and thousands of years. So it’s a really common virus. It’s sort of lived with human beings. And a lot of the time, most of the viruses actually don’t cause much more problems than causing say warts, but the ones that cause cancer, like this one, so the HPV virus, which is really HPV 16, and another one called HPV 18. They’re the ones that cause most human oropharyngeal cancers.

And so when you kiss someone, you might get exposed to it now. Look, we get exposed from when we take up sexual practices and you know. So deep tongue kissing potentially, but really oral sex and other sexual acts.

Julie McCrossin
And it’s so important that we just quickly say that for – correct me if I’m wrong – the majority of people our body, or antibody, our immune system kills it off and you don’t get cancer. But for a small but unlucky group like myself, we end up with cancer.

Richard Gallagher
I couldn’t agree more.

Julie McCrossin
But I want to turn to your robot. You’re dealing with a lot of patients who’ve got HPV cancer in the throat. Why is that Trans Oral Robotic Surgery that we’re seeing now … our filmmaker will show pictures of it … why is that going to improve survival and quality of life for patients? What’s happening now and what will happen in the future?

Richard Gallagher
This has been one of the big, one of the big innovations. So what’s the advantage of the robot? So our friend here, the robot, the big advantage is, when I started my training, and when I used to operate on patients with tongue cancer, or sorry, cancer at the back of the tongue or the tonsil, we used to do big operations.

So we’d make a cut in the neck. We maybe split the jaw bone. Pull everything apart. Go back to the back of the throat and then cut out the cancer. Take some tissue from another part of the body, typically from your forearm, hook it up to an artery and a vein, and then repair everything.

Julie McCrossin
And could I say, I know there will be people watching us now who’ve had that procedure.

Richard Gallagher
Absolutely. And, you know, that’s a big deal. It’s a very, in some ways, although, you know, technically it’s a lot of dividing of tissue and separating things which is quite in a way destructive.

And the problem is that you’re in hospital for weeks on end. You have to have a tracheotomy, temporarily, so a tube into your throat into your windpipe. You have to be fed through a tube, usually just a nasogastric tube, so tubes through your nose into your tummy, but sometimes a tube into your tummy directly called a gastrostomy tube or a PEG tube by people.

Julie McCrossin
So in what way does the robot diminish that level of impact on the patient? But also, if you could tell us what impact does it have because it must also have its own effect?

Richard Gallagher
So absolutely. So those operations that I was talking about, so where we split the jaw or do other things where we’re dividing a lot of tissue and then taking other tissue and putting in the throat. What that does is that it has a much greater impact on your speech and swallowing and the surrounding tissues.

It causes a lot of scarring and often patients who had that surgery would end up needing to have radiotherapy and chemotherapy or radiotherapy alone and, more recently, chemotherapy. And that’s the reason why chemoradiotherapy is a treatment option that started to become really popular in the early 2000s. And it made sense because we are offering less morbid treatment or less, you know,

Not easier treatment, because it’s all tough treatment as you know, but a treatment that was a non-surgical option, which was a good non-surgical option. However, we also knew that patients paid the price for that down the track. So the introduction of the robot, what that’s done, is this means that we can do now do an operation down the throat.

Julie McCrossin
And can I just say, you, as a doctor, sit over there separately, almost like you’re playing a game in one of these computer games. And you move those long things down into the throat of the patient and that little bowl of fruit, I assume is the tumor inside my throat.

Richard Gallagher
So that … the important thing and again, the the robotic surgery is about a team approach as well. So I have an assistant who sits at the bedside. I’ve got a scrub nurse who helps as well. And then there are the other nurses in the operating room who are helping to make sure that everything’s running properly.

But what we’re doing … there are three important parts to the robot at the present time. There’s a camera, which is in the centre here, which is a 3D camera. And then there are these arms, the robotic arms and there are some cannulas here and then at the bottom, you can see some instruments coming out.

Now these instruments aren’t necessarily instruments that we use for robotic surgery for tonsil cancers and base-of-tongue cancers, but they’re very similar. So they’re very small instruments, but they allow you to do some movements and to be able to operate in a confined space and it’s very accurate.

You alluded to the fact I sit over in the corner. The really powerful thing about this is that I’m sitting over there and I’m immersing myself in a 3D environment. And it’s hard to understand. But the best way for me. It feels like I’m down your throat. So yeah, it’s almost like I can put my hand down your throat and pull out the cancer.

Julie McCrossin
And it’s important for people who aren’t familiar with this, it’s very deep down. It’s not like something you can see by opening your mouth and seeing. You are operating deep down.

Richard Gallagher
We’re operating down here. Maybe down at the voice box level, but certainly down in this area here, which you can’t get to through the front of the mouth easily.

Julie McCrossin
And sadly, that’s why many general practitioners may delay in referring us to someone like you … because they look in the mouth and they can’t see a problem. And that’s because it’s deeper down. How many people currently have access to the robotic surgery, if it’s the best option for them, in Australia and New Zealand?

Richard Gallagher
This is one of the big problems. Not everyone can get access to the robot. And part of the problem for that is that there are only certain centres around Australia and certain hospitals that have the robot.

Now a lot of them are actually in private hospitals, rather than being based in public hospitals. And so that brings its own host of problems associated with that. I think it’s really important that everyone be able to get access to the robot. And that means public patients as well, not just private patients.

Julie McCrossin
Are there any public patients getting access to the robot in Australia and New Zealand.

Richard Gallagher
Absolutely. Absolutely, there are. So I mean … for instance, here, at St Vincent’s we treat public patients on the robot. I know that there’s a robot in Western Sydney where public patients have been treated previously. It happens in Queensland. It happens in Melbourne. It happens in South Australia. So I know that that’s the case.

Julie McCrossin
How are we going to improve access? How much do they cost?

Richard Gallagher
So a robot at the moment is around four million dollars.

There are different robots. So they are starting to develop new robots which are coming into play, which may be cheaper and more accessible than this particular robot. But as costs come down, but we save money.

Patients aren’t in hospital for the same period of time. So that’s one of the advantages. Your spend less time in hospital. It may affect your speech and your swallowing initially, but long term, much better results, much better speech, much better swallowing. And so all of your rehabilitation and things are shorter. So you save money.

Julie McCrossin
And it is important for patients watching, it is still, you know, a major surgical experience, but what you’re saying is it’s a lot less than the other approaches.

Richard Gallagher
It’s a much more concise operation, and you’re in hospital for a shorter period of time. The impact on your speech and swallowing is much, much less. And look, you know, to be honest, almost 50% of the patients that I would treat for oropharyngeal cancer, if their cancer is small enough, and I only have one or two lymph nodes in their neck, they get away with having a robotic operation and an operation on the neck to remove lymph nodes and they don’t need radiotherapy.

Julie McCrossin
So what proportion of your patients? Are you able to give me a proportion? Who you’re able to operate using the robot and not require radiation and chemo? And if you could give me a sense of what proportion and what are the characteristics that make that possible?

Richard Gallagher
It’s about one third to 40 percent of patients can get away without needing radiotherapy or chemotherapy. Now, that’s what you’re alluding to. The problem is that patients don’t get access to the robot.

And that is a limitation of centres. If you’re referred to a centre that doesn’t do a lot of head neck cancer work, or where they don’t do robotic surgery. And I think every patient has a right to say, “Well what options of treatment have I got?”

And if you don’t have that option, and you’re not given that option, you should be saying well, asking your doctors, or asking someone. Can I go be offered that and at least go and see someone who does that type of surgery to see if it’s appropriate?

Julie McCrossin
And are there any disadvantages to robotic surgery from a patient perspective?

Richard Gallagher
The disadvantages at the moment are … is about access. But other than that, the disadvantages are … look, not every patient can have a robotic operation. So there are limitations. The tumours have to be of the right size and in the right position. And patients have to be able to have access.

So problems like they have to have good mouth opening. And unfortunately, some people have got cancers in this area, the mouth openings not very good because of the cancer. So they can’t have a robotic operation.

So there are some people who you just can’t do the operations. So that’s a disadvantage. So not everyone can have it done. I think itself, I think the only other disadvantages are … sometimes things don’t work out the way you expect. And patients will get side effects which are worse than what you expect.

And I think that you know, you talk about complications and side effects. We know that a lot of treatments that we do, you get side effects, okay. Whether it be from radiotherapy or surgery or whatever. And they’re not really complications, they are side effects of treatment.

That’s one of the problems with robotic surgery, like every other surgery, is people still get side effects and they still get complications. And sometimes it doesn’t always go right. But it goes right and works a lot better than doing big open operations.

Julie McCrossin
Can I just say as a patient, you’ve emphasized the multidisciplinary team and I was lucky enough to benefit from that. I particularly, I must say, I had a speech pathologist who worked with me for over a year to get me speaking Well again, which mattered to me because I talk for a living. But…

When I was in the acute phase of my treatment, my nurse coordinator stopped me and my partner from going mad with anxiety. It’s the only word to say it but, with these teams, you need a flight manager to help all airplanes land on me at the right time. An air traffic controller.

An innovation I’d like to see, because I’ve benefited from it, is a dedicated nurse coordinator who was able when I was a patient in that acute dreadful phase, when I lost speech all together. So I literally couldn’t speak for myself.

She made sure I saw all the right people, at the right time, and supported my partner who was looking after me as well. Do we need well over 40 specialist head and neck cancer nurses in major cancer centres, just like we’ve got prostate cancer nurses and breast nurses?

Richard Gallagher
Yes. One of the things that I would love to see, and one of the key members of the head and neck team and the multidisciplinary team, is actually the Cancer Care Coordinator, which is usually a really experienced nurse. And ideally, what I’d love to see is supporting these people to develop their skills further to become nurse practitioners.

So that they can do a lot of different things. But … they’re the touch point for patients and their families. And when patients are going through treatment. As you say, it’s really important during treatment.

You get lost, and someone needs to be there that you can lean on, or that you can access to give you advice and point you in the right direction.

So ideally, for me, long term, I want to see nurses who are trained to be able to examine patients. I want them to be able to be trained to use an endoscope, so like we do, to look down someone’s throat.

Because I think in the long term, looking at patients beyond five years and the longer period of time, I really want nurse practitioners to be involved in that management because it’s too much for people such as me.

I have a huge, you know … lots of surgeons, who do lots of cancer surgery, have a huge burden of patients they have to follow over time. And it helps if you’ve got the support of a clinical nurse specialist, nurse practitioner and a cancer care coordinator

But the cancer care coordinators are focused on what’s happening while we’re getting you through the treatment. But long term we need better. And we need to expand that

Julie McCrossin
I can speak for every patient and family in the watching this and say if you could give us a long term nurse coordinator for the next 10 to 15 years, we’ll send you flowers.

Richard Gallagher, thank you very much.

Richard Gallagher
Thank you.

Julie McCrossin
And ladies and gentlemen, this is one of a series of interviews about innovations in care.

We’re focusing particularly on innovations in surgery, and in just a moment we’ll be meeting a nurse who’s very experienced with head and neck cancer patients.

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