Palliative cancer care

Every person in Fife with cancer should have a designated cancer clinical nurse specialist, sometimes called the ‘CNS’.

Cancer CNS's often support people through their pathway to diagnosis and cancer treatment. When cancer treatment is not possible or no longer possible, you may still find it beneficial to have some contact with your Cancer CNS. Usually, this is done by phone or through clinic appointments at the hospital. The Cancer CNS are in close communication with your primary care team and other health professionals as needed.

However, most people with cancer who do not have treatment find that coming to the hospital for appointments becomes less helpful. It may also become too difficult or exhausting. For this reason, most Palliative Cancer Care is provided by your GP and District Nurse Team in the community.

Your general practice team are an important part of your palliative cancer care. A variety of professionals make up the general practice teams. These include: GPs, nurse practitioners, practice nurses, pharmacists, paramedics and other allied health professionals, such as physiotherapists. Not every General Practice team is the same. They may know you from before your cancer diagnosis. They may have supported you through your diagnosis and/or treatment.

It could also be that you have not have needed an ongoing relationship with a member of your team. Regardless of your situation, your General Practice team should be aware of your cancer diagnosis. They should be able to support you going forward. Your team will help guide you to get the right care. The most appropriate person in the team might not always be the GP. We want you to get the right care, in the right place at the right time to suit your needs.

General Practice teams provide a range of palliative care and support including:

• leading your palliative care at different stages of your illness
• visiting you at home when needed
• assessing and managing your symptoms
• reviewing your medications, and stopping any which are not likely to benefit you
• talking about future appointments you may have with the hospital or specialist
• helping you to decide which appointments are likely to be helpful and which ones may not be
• talking about what matters to you, and what your future preferences 
  
  

Your District Nursing team is an important part of your Palliative Cancer Care journey, providing care and support in the community 24 hours a day, 7 days a week. The team will centre care around your needs. This is through a combination of phone calls and home visits. District Nurses provide a range of palliative care including:

• Practical support to help you to manage in your home, assessing your need for personal care, assessing your need for equipment such as  hospital beds and pressure relieving equipment.
• Emotional support for you and your relatives or other close people, adjusting to your diagnosis and changing health.
• Provide support to plan your current and ongoing care
• Clinical support e.g assessing and managing symptoms (including administering medications by injection if this is needed), managing any wounds or catheter issues
• Care coordination by working with your GP and other teams as needed, such as Specialist Palliative Care, Occupational Therapy and others (see below).

Your GP or Cancer CNS can refer you to your District Nurse, or you can self-refer by phoning your GP surgery and asking to be put through to the District Nurse team.

This specialist service comprises a multi-disciplinary team of clinicians. They support patients and families with more complex needs in all care and residential settings, including:

• The Victoria Hospital in Kirkcaldy, all Fife’s community hospitals (Queen Margaret Hospital, Glenrothes Hospital, Cameron Hospital, St Andrews Community Hospital and the Adamson Hospital, Cupar).
• People’s own homes and care homes across the whole of Fife
• The Victoria Hospice, Kirkcaldy (on the Victoria Hospital site, in a separate building)

They offer care and support 7 days a week, delivered by specialist nurses, healthcare assistants, doctors, occupational therapists, physiotherapists, a dietitian, specialist pharmacy, counsellors, spiritual care, a complementary therapist and volunteers.

Specialist Palliative Care is available to those who need an extra level of clinical care and/or support, beyond the care provided by their GP, district nurses, cancer CNS or other teams. Many people with incurable cancer do not need specialist palliative care. This is because their other care providers can meet their palliative care needs. For any GP, District Nurse or other healthcare professional who feels that their patient requires specialist support, there is a 24 hour, 7 day advice and referral line.

The Victoria Hospice in Kirkcaldy offers inpatient care. This is for those who need intensive specialist input. This can be for symptom management where symptoms are particularly difficult. Alternatively, it can also be when the person and their family or carers are experiencing other difficulties such as significant anxiety or distress. Many people who use the hospice come in for one to two weeks to have their symptoms managed and then they return home. Others come to the hospice at the end of their lives and die in the hospice. Most people in Fife do not need hospice care. However, it is available to people whose palliative care needs cannot be met in another setting.

The team provides Inpatient palliative care in many settings in Fife. This includes the Victoria Hospital Kirkcaldy and in our community hospitals. Fife Specialist Palliative Care clinicians are available 7 days a week. 

Illness can affect our physical, psychological, and emotional well-being when it affects our ability to carry out daily activities. Occupational therapy interventions are symptom-led. We use a problem-solving approach to help with everyday activities that people find difficult. For example, they may have difficulty washing and dressing. They may struggle with cooking, getting around their home, and doing enjoyable activities. We use a holistic, person-centred approach to set goals. It makes it easier to do things that improve quality of life and provide a sense of control. This may involve adapting the way we manage tasks. We can also provide equipment to make activities less effortful.

If there is already an Occupational therapist (OT) involved in a person’s care, they may be able to meet any needs. All OTs from the Fife Health and Social Care Partnership have a role within palliative care.  The Community Palliative OT service is part of the Specialist Palliative Care service. It is a Fife-wide service. Any healthcare professional can refer into this service.

Community OT Telephone: 03451551503

The Palliative Care Occupational Therapy team works as part of the Specialist Palliative Care service covering all wards in Victoria Hospital and the Hospice. 

Referrals are made directly by the clinical staff, but any patient or family member can also ask their ward team to refer them for an Occupational Therapy assessment.

Physiotherapy focuses on maintaining and improving movement, function and strength. Physiotherapists will look at maintaining and improving mobility. They also help people to self manage their symptoms.

Physiotherapists can help patients to manage at home and can offer advice and support if mobility gets worse. We can provide some equipment to aid with maintaining independence for functional activities. Examples would be mobility and washing/dressing.

Any GP, district nurse, cancer CNS or wider clinician can refer a patient for a physiotherapy assessment. Hospital physiotherapy teams will offer this. Or in the community, the ICASS (Integrated Community Assessment and Support) will offer this. 

Social care services are there to help support you at home. They work out your needs and help find local resources. This may include support to help you with jobs such as cleaning and cooking. It may also be able to help support you with some personal tasks such as washing and dressing. Your GP or District Nurse can refer you, or you can self-refer by contacting your local social work department:
Telephone: 03451 551 503                      
Email: sw.enquiries@fife.gov.uk

Cowdenbeath Social Work Office
Fife Council Brunton House High Street Cowdenbeath Fife KY4 9QU

Cupar Social Work Office
County Buildings St Catherine Street Cupar Fife KY15 4TA

Dunfermline Social Work Office, Lynebank Hospital
Halbeath Rd, Dunfermline KY11 8JH

Glenrothes Social Work Office
Fife House North Street Glenrothes Fife KY7 5LT

Kirkcaldy Social Work Office
Town House 2 Wemyssfield Kirkcaldy Fife KY1 1XW

Leven Social Work Office
Carberry House Scoonie Road Leven Fife KY8 4JS