Pastoral tutorials

Question 1

What are the advantages of the watch and wait approach?

Answer 1

Delays potential toxicities of chemotherapy or targeted therapies.
Maintains quality of life in asymptomatic patients.
Allows for new therapies to emerge, which may be more effective or have fewer side effects.

Question 2

What is the DAWN clinic?

Answer 2

The DAWN (Diagnose, Assess, Watch, Notify) clinic is designed for patients with indolent haematological cancers, such as chronic lymphocytic leukaemia (CLL) or low-grade lymphomas. It follows a watch-and-wait approach, monitoring patients regularly through clinical reviews, blood tests, and imaging. Treatment is only initiated if disease progression occurs or symptoms worsen, helping to avoid unnecessary treatments and side effects in the early stages of these slow-progressing cancers.

Question 3

What do you need to provide before you gain consent for treatment?

Answer 3

• Time (At least 24 hours)
• Information
• Other treatments
• Risks vs benefits

Good practice to get the patient to repeat back treatment plan and specific side effects

Question 4

Should you involve family in decisions about treatment?

Answer 4

Yes always best practice.

Power of attorney?- make sure you ask whether it is to do with finance or health

Ask for legal proof

Question 5

Why do cancer patients experience anxiety about follow-up scans?

Answer 5

Fear of recurrence or progression.
Uncertainty about scan results (“scanxiety”).
Emotional toll of regular monitoring.
Impact on mental health and quality of life.

Question 6

How does a cancer diagnosis affect access to travel and life insurance?

Answer 6

Higher premiums or exclusion of cancer-related coverage.
Difficulty obtaining insurance, particularly if actively undergoing treatment.
Limited options for high-risk patients.

Question 7

What challenges are faced in balancing immunotherapy with its side effects?

Answer 7

Immune-related adverse events (e.g., pneumonitis, colitis).
Need for close monitoring and prompt management.
Balancing therapeutic benefits with quality of life.
Potential for long-term autoimmune complications.

Question 8

Why do some cancer patients struggle with decision-making responsibility?

Answer 8

Feeling overwhelmed by complex medical information.
Fear of making the “wrong” choice.
Emotional burden of choosing between treatment options.
Prefer leaving decisions to their healthcare provider.

Question 9

How is managing multiple specialties important in cancer treatment?

Answer 9

Coordinating care between oncology, haematology, radiology, and surgery.
Multidisciplinary team (MDT) approach for personalised treatment.
Ensures comprehensive care across different treatment modalities.

Question 10

What role does NICE play in the pricing of haematological drugs?

Answer 10

National Institute for Health and Care Excellence (NICE) assesses cost-effectiveness.
Recommends which drugs are funded by the NHS.
Balances clinical benefit with economic considerations.

Question 11

What is a specialised commissioning hospital and how is it funded?

Answer 11

A hospital designated for highly specialised care (e.g., complex cancer treatments).
Receives a set sum of money from NHS commissioners.
Responsible for managing the budget to deliver specialised services.

Question 12

What is the difference between commercial and university-led clinical trials?

Answer 12

Commercial trials: Funded by pharmaceutical companies, often come with financial support for the hospital.

University-led trials: Typically do not provide additional funding, focus on scientific research rather than profit.

Question 13

How do trials in London/Oxford offer access to newer cancer treatments?

Answer 13

Leading centres for clinical trials, often first to offer cutting-edge therapies.
Patients may access experimental treatments not yet widely available.
Opportunities for early use of novel drugs through clinical research

Question 14

What challenges exist for cancer drugs that are still under patent?

Answer 14

Under patent protection, meaning they can only be purchased from the developing pharmaceutical company.
Limits affordability and accessibility until generic versions are available.
Expensive, creating challenges for widespread use in the NHS.

Question 15

Why do sickle cell patients come under haematologists immediately?

Answer 15

• Sickle cell disease is a haematological disorder requiring specialised care
• Haematologists manage complications such as vaso-occlusive crises, chronic anaemia and the need for transfusion therapy
• Early involvement ensures comprehensive care and reduces disease-related complications

Question 16

Why might sickle cell patients not have their pain relief taken seriously, and what is the consequences?

Answer 16

• Sickle cell pain is often under-treated due to misconceptions about opioid use and pain exaggeration.
• Inadequate pain control can lead to chronic pain syndromes and psychological distress.
• Chronic pain in sickle cell disease can significantly reduce quality of life.

Question 17

What is hyperhaemolysis and how is it treated?

Answer 17

• Hyperhaemolysis occurs after multiple transfusions where the body destroys both transfused and native red blood cells.
• Treatment includes corticosteroids and intravenous immunoglobulin (IvIg) to modulate the immune response and halt haemolysis.
• Red cell exchanges may be needed to manage anaemia and avoid further transfusions.

Question 18

How does hydroxycarbamide work in sickle cell disease?

Answer 18

• Hydroxycarbamide increases foetal haemoglobin (HbF), reducing the concentration of sickled haemoglobin (HbS).
• This dilutes HbS, leading to fewer sickling events and reduced vaso-occlusive crises.
• It is used to prevent organ damage, especially in children, as a long-term disease-modifying therapy.

Question 19

What are the challenges of managing sickle cell patients who are Jehovah’s Witnesses?

Answer 19

• Jehovah’s Witness patients may refuse blood transfusions due to religious beliefs.
• This can complicate acute management, particularly in life-threatening anaemia or crises where transfusions are standard.
• A Jehovah’s Witness Liaison Committee may counsel patients to help them make informed decisions, balancing faith and medical risks.

Question 20

What is POEMS syndrome, and how is it associated with haematological conditions?

Answer 20

• POEMS syndrome is a rare paraneoplastic syndrome associated with plasma cell disorders.
• It stands for Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein, and Skin changes.
• Often managed by haematologists due to its association with plasma cell dyscrasias.