Objectives This project aimed to identify the complex issues faced by teenagers and young adults (TYA) attending University College London Hospital (UCLH) for molecular radiotherapy treatments (MRT). UCLH specialises in treating TYA patients with cancer and is the national referral centre for MRT. Families often travel from afar for treatments and are then admitted to hospital and placed under radio-active precautions. A Health Needs Assessment (HNA) was introduced at UCLH so that health professionals could learn more about their patients prior to admission and treat them more holistically. The HNA also aimed to combat the potential feelings of anxiety and isolation that some patients faced when undergoing MRT. This project analysed the information gathered in the HNA in order to understand the TYA experience more fully, and to look at the resources required to respond to the issues identified.
Methods This was a retrospective case note review of TYA patients who received MRT on a paediatric ward at UCLH over a 13 month period (after the introduction of the HNA; from January 2018 to February 2019). Each patient’s HNA was reviewed in order to identify the issues picked up. Notes from the radiotherapy MDT were also reviewed in order to assess the resources needed to address any issues identified.
Results Over a 13 month period, 16 TYA patients or parents/carers completed the HNA prior to their admission for MRT. These patients had an age range of 12–21 and the mean age was 17 years. Psychological issues, such as stress, anxiety or poor mental health were reported in 31% of patients and in 38% of parents/carers. 12.5% reported an issue with nutrition, but only 6% mentioned concerns around missing school or education. 44% had financial concerns, such as loss of income surrounding prolonged ill health and repeated hospital admissions. When asked about other concerns, 25% were mentioned the isolation of the treatment, 13% were worried about the unfamiliar environment, 25% expressed concerns about the success of the treatment and 19% expressed anxiety around potential side effects. 5 of the 16 MDT discussions were available for analysis; of these, 40% of patients required referral for psychological support and 60% required signposting to financial supportive services. 1 TYA patient needed input from 4 different members of the radiotherapy MDT.
Conclusions This project provided an insight into the complex issues experienced by TYA patients and their families when they are faced with difficult diagnoses and require specialist treatments such as MRT. The HNA used by UCLH is a useful tool for beginning a conversation about these issues and in understanding a patient more holistically prior to their admission to hospital. The adolescents studied in this group experienced psychological issues and financial difficulties; they were concerned about being isolated during their treatments and worried about their long-term prognosis. Of the MDT outcomes that were available for analysis, a high proportion needed input from members of the radiotherapy MDT, supporting this approach to their management.
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