By Katie McLaughlin, Clinical Lead Dietitian, Macmillan Integrated Therapy Service at SaTH
Macmillan Dietitians are experts at assessing and treating a wide range of nutritional issues that can develop as a result of cancer or its treatment. We identify patients who are at high risk of malnutrition and work to maintain their nutritional status during treatment.
We discuss common barriers to eating and recommend strategies that can help. Food is often the one thing patients have control over and so it’s important for me to be their advocate as many families and medical professionals cannot understand why a patient doesn’t want to eat.
Nutrition is important because there is good evidence that a healthy lifestyle will help you feel better as well as reducing the side effects of treatment, cancer recurrence and improving survival rates. Everyone’s nutritional needs are different and I do a lot of myth busting as there is so much misinformation out there in terms of cancer and sugar, dairy, alkaline diets and ‘superfoods’. No two days are the same!
I work across The Royal Shrewsbury Hospital and the Princess Royal Hospital in Telford on the wards and I see patients in radiotherapy, the Chemotherapy Day Centre and the O’Connor Haematology Unit. I also on occasions do home visits, often with the Speech and Language Therapists.
As well as being part of the wider Multi-Disciplinary Team (MDT), I’m part of the Macmillan Integrated Therapy Service that consists of Dietitians, Speech and Language Therapists, Physiotherapists and Occupational Therapists. I am also supported by two Assistant Practitioners.
In my role I see a range of cancer patients including: head and neck, upper gastrointestinal (UGI), pancreatic, bowel, lung, breast, Lymphoma, Myeloma and Leukaemia.
Initial patient assessments take up to an hour or longer – I explain my role through treatment, the importance of nutrition and maintaining weight. Many of our patients have prophylactic feeding tubes inserted and so I spend time explaining the rationale for this and how it works.
It’s imperative that I am organised so we have several systems and processes so we can keep track of our current inpatients, who needs to be seen in the day units, radiotherapy and those who require a telephone call on any given day. From then onwards:
- My day normally begins with a morning huddle where we can plan/prioritise the workload for the day; this involves looking at the PSAG lists and clinical portal for our inpatients and looking in the particular day of the week for outpatients, I then check and respond to telephone messages and emails.
- I attend a weekly MDT meeting for head and neck cancer patients where I am a core member as well as a radiotherapy MDT meeting where we discuss all the head and neck and UGI patients undergoing radiotherapy and patients who will be starting or have finished treatment .
- On a Monday afternoon I attend the Head and Neck MDT clinic where I see new diagnoses, review patients and explain my role through their treatment and monitor how people are coping post treatment.
- I do a joint rehab clinic on Wednesdays for post radiotherapy patients with the Trust’s Speech and Language Therapist. Often seeing head and neck and UGI patients, in these clinics we spend dedicated time addressing concerns and advising on strategies to help manage treatment side effects. From a dietetic point of view we are working towards getting patients back on oral diet and weaning them off their PEG (percutaneous endoscopic gastrostomy) feed so the PEG can be removed.
- I work closely with the wider MDT, liaising daily with Doctors, Clinical Nurse Specialists, Radiographers, Nursing Staff, Healthcare Assistants, Housekeepers, Dental Hygienists and other Advanced Healthcare Practitioners. I also link with other hospitals providing a handover of patients or discussing patients that have had treatment in another area and require local follow up.
- A lot of my time can be non-direct patient contact – writing feeding regimens, GP prescriptions, writing letters to the patient, GPs and Consultants, as well as referring on to other services such as the lymphoedema clinic at the hospice, Get Active Feed Good, Macmillan cancer information centre or welfare and benefits.
- I also supervise dietetic students throughout the year, which often means supervising peer assisted learning activities or taking them to see patients.
I love my job and couldn’t imagine specialising in any other area. Sometimes it can be very sad but it’s great to see patients through the treatment journey out the other side and recovering. Patients are always very grateful for my support and it’s extremely rewarding.