High global ranking for ortho-oncology service leaves RNOH therapists feeling humbled and excited

Focus is on the individual

When limb reconstruction is not an option then amputation is often required. The amputation therapy team has a unique role and works with adults and children through their whole journey. From the point of diagnosis, there is an option to discuss the process prior to surgery and the same therapy team follows the patient during their inpatient stay post-surgery. In addition, if patients so wish, they can return to RNOH for their prosthetic limb provision and rehabilitation.

The prosthetic rehabilitation unit is based on the Stanmore site in north west London. This large multidisciplinary team supports children and adults throughout their lives, helping them to achieve goals as a prosthetic or wheelchair user. Patients can access to a wide variety of equipment, including the Bioness Vector Gait and Safety System, the Aspire Centre gym and pool and the motor learning lab. This ensures that rehabilitation is not only individualised but is an enjoyable experience for everyone.

'Fun and engaging' approach

The prosthetic rehabilitation unit caters for all levels of amputation and congenital limb deformities. Patients requiring amputation for sarcoma often have higher levels of amputation (for example, hip disarticulation, transpelvic and upper limb amputation, such as forequarter and shoulder disarticulation). All patients have access to state-of-the art prosthetics components, such as microprocessor knees, multiarticulating hands and sports limbs for children, as part of NHS provision.

We are the largest paediatric sarcoma therapy service in the UK and mainly see children with bone cancer and soft tissue sarcoma from south east England. As a team, we focus on making rehabilitation fun and engaging with age-appropriate games and activities, from surgery through to return to school and sports. We are currently developing our rehabilitation pathway for these children and their families to help them reintegrate back into school and other day-to-day activities.

We do this by using both virtual and face-to-face appointments to help minimise disruption to their daily routine with the support of local services. Paediatric band 7 Rebecca recently was shortlisted for the Innovation and Improvement in Integrated Care Systems category of the NHS Chief Allied Health Professions Officer awards for her work.

The RNOH Motor Learning Lab provides a 3D gait measurement service and a virtual reality gait rehabilitation service to the sarcoma team which uses the Motek GRAIL system. The MLL team (Roisin Delaney, Dr Matt Thornton and Olivia McVeigh Mellor) also support valuable research for our team and others at RNOH.

Consisting of five physiotherapists, three occupational therapists and a wonderful therapy tech, the team strives for excellence, innovation and compassion for our patients and staff [Shea Byrne]

What makes working in our team different?

We run a busy inpatient, outpatient (including hydrotherapy and gym) and rehabilitation services which allows great continuity for patients and staff. Working closely with our team of surgeons, ward nurses and clinical nurse specialist allows for a multidisciplinary approach that focuses on patient care. We also have an ortho-oncology specific occupational therapist pre-assessment and outpatient service which is quite rare which assists patients to return to work and functional tasks.

We also value research and our dedicated sarcoma research physiotherapist, Dr Sherron Furtado, facilitates great internal and external projects, and we have the opportunity to work with Masters students. At the most recent European Sarcoma conference, four posters and 10 oral presentations were completed by our adult, paediatric and sarcoma research team.

Staff wellbeing initiatives

We place a strong emphasis on teamwork and staff mental health. Working in cancer can be difficult and we value having a good work-life balance. We love having shared lunches, bake-offs, fitness challenges, theatre evenings and having fun at work. Our team culture is exemplified by many of our rotational staff returning to become static team members because they are passionate about working in this team.

Furthermore, we believe in and action the progression of staff. Shea, our current team lead, runs a 10-year physiotherapy sarcoma follow-up clinic to ensure our patients are supported in the long term. Kate, our senior occupational therapist, facilitates HOPE and health and wellbeing sessions and is completing a research apprenticeship. Our previous therapy lead physios, Suzie and Abby, now work in innovative new roles with sarcoma at RNOH.

Specialist physiotherapy role (Abby)

It was proposed that a highly specialist physiotherapist working within the sarcoma MDT had the potential to transform pathways of care, enabling the safe and effective sharing of skills across traditional professional boundaries. The Sarcoma Service at RNOH Stanmore wanted to embed a stratified model of follow-up, utilising nursing and physiotherapy to ensure optimal post-surgical follow-up while embedding holistic needs assessment, end of treatment (EoT) summary, and health and wellbeing support.

Commencing in January, two years of Macmillan funding was secured to enable a physiotherapist to work alongside an already established nurse consultant. The new pathway allows patients to be seen by a consultant at six weeks post-op and then a physiotherapist at three months for electronic health needs assessment and EoT summary, as well as routine surveillance. This embeds personalised cancer care and a more holistic approach into follow-up which is then shared by nurse and physiotherapist, with the patient seeing a consultant for one-year reviews. 

Data collected so far indicates that this new role is beneficial by, for example, improving quality of care and enabling release of consultant time. Next steps are to review the staffing requirements to adequately support the entire surgical team and carry out further analysis of patient experience and expectation. A review of further services will help to ensure patients are followed up in a holistic way. 

Personalised cancer care lead role (Suzy)

Suzy was appointed as the Macmillan personalised cancer care (PCC) project manager in January 2020. We completed initial scoping for the project to understand what aspects of PCC were already in place in the service. We created a steering group with members of the nursing, medical, allied health professional, psychiatric, management teams, and the service development lead, taking part. It was established that, within the service, there was no formal PCC work being undertaken at RNOH, although the team offers a high standard of care and support to patients that included aspects of PCC. Objectives were then set and worked towards.

Our achievements include

• holding virtual health and wellbeing sessions  
• rolling-out the RNOH HOPE Programme. We hold this course virtually to allow patients to attend, regardless of their location
• rolling-out and developing the end of treatment clinics run by the Macmillan-funded highly specialist physiotherapist and nurse consultant 
• piloting and developing joint EoT clinics between University College London Hospitals NHS Foundation Trust and RNOH. These are run by an advanced nursing practitioner and a highly specialist physiotherapist for patients who havehad surgery and radiotherapy
• further development of stratified follow-up: three steams of stratification (this work will look at patient benefit, patient experience as well as the impact on the service) 
• surgical-led follow-up
• nurse-led follow-up
• highly specialist physiotherapist-led follow-up

• improvement in patient engagement for both health needs assessments and health and wellbeing sessions
• continued analysis of the emotional/psychological/psychiatric needs of sarcoma patients – working alongside the psychiatric service. Further exploring the need for a highly specialised OT for mental health and physical function

'We think RNOH is a great place to work and highly recommend it to therapists who want to specialise in rewarding areas such as ortho-oncology, complex orthopaedics, musculoskeletal, paediatrics, amputees, chronic pain, upper limb and spinal cord injury.

'We love spreading knowledge of sarcoma and what we do at RNOH. Don't be afraid to reach out if you think your service would benefit from training or want to learn more. Email us with any queries. Thank you for reading this article! Shea Byrne, ortho-oncology therapy lead

The team would like to thank its charity partners: Macmillan, Sarcoma UK, Bone Cancer Research Trust and the RNOH Charity.

Contact details/social media

Email: RNOH.ortho-oncologytherapyteam@nhs.net

Twitter: @OrthoOncTherapy @RnohTherapies @RNOH_MLL @RNOHProsthetics @RNOH_PCC @MSKOncResearch

To see PhysioUpdate's news article about the 2022 Newsweek poll results and the RNOH's response, visit: https://www.physioupdate.co.uk/on-the-move/newsweek-names-rnoh-one-of-the-worlds-best-specialised-hospitals-in-orthopaedics-category/