Teamwork is the key to improving treatment

STATE-of-the-art cancer treatment means teamwork. While health service planners digest the implications of the plans for cancer services some local centres are quietly getting on with it, writes Celia Hall.

Patients referred to the cancer unit in Southampton will meet at least three senior doctors and a specialist nurse. Other professionals behind the scenes - anaesthetist, pathologist, haematologist, radiologist and their staffs, operating theatre, laboratories and other clinics - will be involved with the care of one patient with one cancer.

'Take a man with a lump in his neck,' says Michael Whitehouse, Professor of the Cancer Research Campaign, Medical Oncology Unit, Southampton University. 'It is not painful but after a bit he goes to his GP. He examines him and may give a course of antibiotics for an enlarged lymph gland.

'He is back after two weeks. The lump may be a little bigger. The GP takes a decision to refer him on to the next stage. He will arrange for him to have a biopsy in the local hospital. The GP may refer him to the best surgeon but they are often the busiest so there will be a delay.'

In the Southampton unit they do a little better. 'We try to do the biopsy within three or four days but you can see that three weeks may already have gone by since the patient decided to go to his doctor.

'After the biopsy, it takes the laboratory, another three or four days and there may be a weekend in between.' All this time, without considerate extra care, the patient is living in fear of his life.

Professor Whitehouse first sees the patients and then liaises between his surgical colleagues. 'In the first consultation I will discuss what might happen and explain what will happen at the biopsy. I will say we need to do this to rule out cancer. I will have introduced the word.' The patient may also be given patient information leaflets relevant to his condition.

After positive diagnosis, as much as possible is done to help. 'This person has just had a dreadful shock but a greater burden sometimes falls on the relatives. Fortunately we have a liaison nurse, funded by the Cancer Relief Macmillan Fund, who will provide advice and information.

'We then try to keep the interval between diagnosis and treatment very short. It is not perfect but it is better to work like this.'

(Photograph omitted)