Video transcript
Innovations in Surgery Part B
The Head & Neck Cancer 2020 Video Series is brought to you by St Vincent’s Hospital Sydney & The Kinghorn Cancer Centre. In this episode we talk to Clinical Nurse Consultant Suzie Flynn about innovations in surgery for head & neck cancer patients & the role of the Cancer Care Coordinator. For more information please visit our website or our You Tube channel. The podcast versions can be found on our SoundCloud channel.
Suzie Flynn, Clinical Nurse Consultant, St Vincent’s Private Hospital.
Julie McCrossin, Head & Neck Cancer Survivor
Julie McCrossin
Hello, I’m Julie McCrossin and welcome back to our second segment on innovations in surgery for head and neck cancer patients. And this is part of a series looking at innovations in treatment and care in order to improve survival, but equally importantly, quality of life to reduce side effects.
You may have already heard our interview with ENT surgeon, Dr. Richard Gallagher. And he’s talked about the robot, the Trans Oral Robotic Surgery. Well, I’m now meeting another member of a multidisciplinary team working with head and neck cancer patients and she has worked as a nurse coordinator. So let’s meet her now. Suzy, tell us what job you’re doing right now. Can you introduce yourself and tell us your current job? And then your past history, particularly with head and neck?
Suzie Flynn
My name is Suzie Flynn and currently I’m a CNC for cancer services and palliative care at St Vincent’s, Private.
Julie McCrossin
And what’s a CNC?
Suzie Flynn
A Clinical Nurse Consultant, so a specialist in their field. But previously – I’ve just recently started this role – but for the past 10 years, I’ve worked as the cancer care coordinator in the surgical head and neck ward at St Vincent’s Hospital.
Julie McCrossin
And we were discussing earlier in this session on innovations in surgery, how multidisciplinary teams are vital. And how an expert nurse as a coordinator is crucial. I felt that as a patient, can you explain it from the nurse point of view? What was your coordination role? And how did it improve survival and quality of life for patients? Why should there be more nurses like you were?
Suzie Flynn
Well, cancer care coordinator is basically the patient’s point of contact throughout their whole cancer journey. So I would have met the patients, not met them physically, but spoken to them on the phone, prior to coming to our multidisciplinary team meeting. So they would have known me, as well as the surgeon. We are kind of the two people that they would know or who they were meeting.
And I would guide them through the whole meeting. And then I would guide them through their surgery. And then, if they needed any care afterwards, or any other treatment, such as radiotherapy or chemotherapy, I would have seen the patient everyday post-surgery. So if they have any questions, as I said, I’m the big focal point of contact. I can get hold of anyone on the team very quickly for a patient, while they’re sitting in the bed or the family members are sitting beside them.
And it’s a very anxious time for the patient and the family. So you have to be very mindful of that. You know, not just of the physical side effects the patients get, but also the emotional side, the emotional wellbeing of the patient and the mental health of the patient. You know, with head and neck surgery, you can’t really hide too much unless it’s inside. If it’s outside. It’s quite visible.
Julie McCrossin
I had radiation and chemo and I didn’t have surgery. So I’m not as familiar with surgery. Can you imagine that some of the people watching this may have just got their diagnosis, give us a sense of some of the emotional and physical challenges a patient can face and the improvements you’ve seen both in physical care and emotional support?
Suzie Flynn
Depending on the surgery, obviously, Julie. It depends on the physical side effects post-surgery. A lot of people come back with a breathing tube called the tracheostomy. Which is a breathing tube into the windpipe. That’s only temporary. It’s only in for a few days. But that can be quite distressing. Because people can’t communicate. They have to write down. They can’t speak.
And other people come back with feeding tubes sometimes. It can be temporary. And there’s a nasogastric for a few days to let swelling reduce down. But also permanent tubes into the stomach called PEG tubes, feeding tubes. And these can be permanent. So people have to, you know, get used to a different way of life post-surgery. Some of it can be long term. Some of it can be short term.
So it’s just helping the patient along the way. And it’s a lot of education explaining, explaining, explaining and letting them know that no question is, you know, silly. All questions are relevant. And with the emotional side of things, it’s, you know, people can have facial disfigurement, you know, which can lead to depression, you know, mental health. We have to look at everyone as a whole, not just one small part. You know, they’ve had, you know, their larynx removed, but you have to look at the patient holistically. And that’s why, I think, an innovation recently, in recent years, has been an excellent MDT, multidisciplinary team, so you work as a whole.
Julie McCrossin
So explain again, what an MDT is. And why is that an innovation that has improved the life of the patient and their family?
Suzie Flynn
Well, you’re getting many, many specialists together in one room to discuss the patient’s care. A patient’s journey from start to completion. So you get in specialists, ENT surgeons, plastic surgeons. Then you’re getting allied health which is speech pathologists, social workers, dietitians. And you get nursing staff and cancer care coordinators, nurse practitioners. Everyone into one room. Everyone’s specialized in their own fields. But…
One person can’t do the job without the other one being there as well. It has to be everyone together. And I think that’s another thing for patients for survival as well and for greater outcomes. If you have specialists in the one area looking after the patient, and survival outcomes are better.
Julie McCrossin
I think I should reveal to the audience that you were my nurse coordinator when I was a patient. And how I remember you is that you gave me your telephone number and that if I needed anything, either I or my partner Melissa would ring you. And amazingly quickly a dentist would ring me, or a doctor would ring me, or a speech pathologist with ring me. You seemed to have the respect of your team and they would move quickly when you needed them to contact someone. Is that a fair summary?
Suzie Flynn
Yes, yes, that is a fair summary. And I suppose that is our job to know when to contact consultant, when to contact someone and have your referrals appropriately done. And you nearly preempt when the patient needs one. You’re already thinking maybe two steps ahead of them, of when they need it. And I suppose that comes with time and experience in the role as well.
Julie McCrossin
And apart from the team, is there any other improvements, innovations or changes that you think have made it better for this head and neck patient?
Suzie Flynn
Well, I know Richard has spoken about the robot but that has been a big change for patients.
Julie McCrossin
What do you see, as a nurse, in terms of the difference for a patient?
Suzie Flynn
Well it’s less invasive. Less time under anaesthetic. And they’re functioning a lot better with their speech and swallow post the robots. You know, they can be a bit swollen for a couple of days, but that goes down quite quickly.
And another big thing is their length of stay in hospital is reduced, which is good, first because not all of our patients are from metropolitan area. We have a lot of regional patients, and sometimes they can only travel up on their own. So to be in a big new city, you know, some of have never been in cities before. You know, it’s nice to say that you are going to be in for three or four days, instead of two weeks.
Julie McCrossin
Are there any other improvements we need for rural and remote patients? Because you do you have met a lot of those patients.
Suzie Flynn
I have met a lot of those patients and I suppose, with my job as well, I coordinated when they go back to rural areas. I tried to link them in with a rural nurse that’s based there. But not all areas have specialist nurses or have care coordinators unfortunately. Not like other tumor streams like cancer prostate.
I would love to see head and neck specialist nurses all around Australia in every state.
Julie McCrossin
Why?
Suzie Flynn
Because I think it would be better for their outcomes, for their long term side effects, if they have a specialist nurse in their region, that can be their point of contact. They still will have a point of contact where they’ve been treated in the centre. But I think it’s important to have someone closer to home that they can ring. And then that person can ring, say if it was me, you know, and we can discuss and I can discuss it with their team here.
Also I think for the specialist nurses it would be great if we had them around Australia, in every state, that they could even link in with Telehealth which is a whole new thing at the moment now due to COVID…link into our multidisciplinary team meeting and see how it’s run and get a sense of that.
Julie McCrossin
And we’ve got people watching this from New Zealand as well because many of the colleges, of course, include Australia and New Zealand in them. And one you mentioned explaining again and again and again. And can I just say, as a patient, if there’s one thing I’ll always be amazed at, is from the moment I was told I had stage four cancer I lost about at least 50% of my cognitive function.
I couldn’t remember anything anyone was saying to me. I had trouble understanding. And then once you started giving me pain relief, the opiods, you know…
I guess what I’m trying to say is : the role of the nurse coordinator to really check if we understand and to repeat. Could you just explain that? How do you know whether someone understands or not?
Suzie Flynn
Well, after the patient initially gets their diagnosis, I would speak to them and say, “right, did you understand everything that was told to you today? “
Julie McCrossin
And what do people normally say?
Suzie Flynn
They go… I got 2% of it . And 98% I didn’t hear. Because they heard the word cancer. And unfortunately, that is, that’s why I would do a follow up call the next day as well. And we go through the whole meeting again. And I’d say, so tell me exactly what you understood from yesterday. And then I’d start from there and then we’d build on it. I’d ask patients if they use the internet. If they use technology like that, because there’s great websites out there.
Julie McCrossin
One website that I think is marvelous is BeyondFive… www.beyondfive.org.au. And the other thing I mention is Cancer Council Information and Support Line 13 11 20. I mean, they’re incredibly helpful.
Look, before I let you go, Suzie, is there any other change you would like to see? You’ve mentioned having specialist head and neck cancer nurses in a network, being able to share information by Telehealth or even by conferences or special training. You’ve mentioned the innovation in surgery with the robot has been very helpful for those who are eligible for it or who have access. Is there anything else you’d like to add?
Suzie Flynn
I’d like to see the patient have a better plan when they’re finished their treatment. Their initial treatment can last for six months to a year. You know, it depends on what treatment people are getting. But I’d like them to have a plan when they leave here, say from one to five years, and then after five years, they get a different plan.
And so they have all the appropriate numbers. They know when to come back for scans. They know who to call if they can’t come for follow up.
It’s very important that patients come for follow up. They’ve done all this hard work with these complex cancer. And then if they get lost to follow up, you know, it’s very hard and especially for the regional and remote patients. So I think we need coordinators, nurses like myself, to keep them in the loop, keep them coming back.
Julie McCrossin
Susie Flynn you’ve been fantastic to talk to and I just have to share with our audience that when I was having chemo…and I have very, very deep veins, we’ll do a close up on my hand later…after a number of people had tried to get the canula in they called “the master “, they called you, and you came in and you got it straight in. So I will love you to the day I die.
Suzie Flynn
Thank you, Julie. Thank you.
Julie McCrossin
And Susie Flynn, nurse coordinator, part of our video today on innovations in relation to surgical care for the head and neck cancer patients. And we’re about to meet a terribly important member of the team, speech pathology. Just come back in a sec.
End of transcript