Expanding my clinical team

Dr Brett Leavers, Nurse Practitioner Lisa Heathcote and Assoc Prof Richard Gallagher

Meeting the needs of head and neck cancer patients

Head and neck cancer treatment is difficult, complex and overwhelming for patients and carers. By adding two specialist head and neck clinicians to my practice I plan to improve patient support.

Over the past ten years my practice has changed enormously. I now spend the majority of my time caring for head and neck cancer patients. Many people think that the incidence of head and neck cancer in Australia is in decline. This is indeed true of the traditional patient with a long history of heavy smoking and drinking. But in fact the number of head and neck cancers is increasing. This is due in part to the human papillomavirus (HPV) related oropharyngeal cancer epidemic and also an aging population.

The good news is that we are getting better and better results and higher rates of cancer survivorship.  This means that like many cancer specialists I have a growing number of patients who require ongoing care and longer term monitoring. The follow up protocols for head and neck cancer patients are demanding. Patients require regular monitoring and treating specialists must remain highly vigilant, all of which is appropriate for such aggressive cancers. It is not as though you can just go to your GP and get x-rays done. The follow up needs to be performed by a clinician with specialist training and the appropriate equipment to examine your throat thoroughly.

Follow up should be individualised. Patients are usually followed up to a minimum of five years after the completion of treatment, with a prolonged follow-up for selected patients.

Frequency of follow up appointments diminishes over time
Year Frequency
1 every three months
2 every three to four months
3 every four months
4 every six months
5 every six to twelve months
6 varies depending upon site and type of cancer
Source: Optimal care pathway for people with head and neck cancers p29

With hundreds of surviving patients at various stages of the follow up cycle this means I spend a lot of time seeing review patients. A couple of years ago I had to face up to the fact that more and more of my time was being diverted to reviewing patients who were progressing well and nearing the five year post treatment mark. Which would have been fine except it came at the expense of time I needed to care for patients who were newly diagnosed. I feel a huge responsibility to ensure patients are reviewed appropriately after treatment but I also am ethically and legally compelled to treat newly diagnosed patients with appropriate urgency. I realised that I, my staff and my patients needed additional clinical support. Finding people with the appropriate training, values, and communication skills took time. Which is why I am so delighted that Brett and Lisa are finally part of my practice.

Dr Brett Leavers – Otolaryngology Head and Neck Surgeon

Brett is a talented, compassionate and highly trained Otolaryngology Head and Neck Surgeon who shares my passion for treating patients with diseases of the head and neck, particularly cancers and airway reconstruction. I have trained and mentored Brett over the past three years and many of my patients have met him either in his capacity as my locum or as the inaugural St Vincent’s Head and Neck Advanced Surgical Training Fellow. Brett sees his own head and neck cancer patients and also sees patients of mine who are progressing well beyond acute treatment. In addition to seeing head and neck patients Brett also sees general otolaryngology (ear nose and throat) patients, including children. Brett attends every St Vincent’s Head and Neck Multidisciplinary Team (MDT) meeting and works across the campus in both the public and private hospitals. Many of my longer term review patients have their annual follow up consultations with Brett. He also sees current patients if there is an urgent problem and I am unavailable. If Brett diagnoses or suspects a complication or a recurrence then we discuss the patient together before agreeing next steps. Brett is highly trained, a talented surgeon, clinically astute, and enormously likeable. Somehow I suspect he is more popular in the practice than me. You can read more about Brett in his own words at his website.

Lisa Heathcote – Head and Neck Oncology Nurse Practitioner

A Nurse Practitioner (NP) is a Registered Nurse (RN) experienced in their clinical specialty, educated at masters level, and who is endorsed by the Nurses and Midwives Board of Australia. While Nurse Practitioners have been a part of the health industry in the UK and USA since the 1960s, the role did not develop in Australia until the 1990’s. Currently there are just over 1,800 Nurse Practitioners working in Australia. In joining my practice Lisa is now the third Head and Neck Nurse Practitioner in the country.

Lisa’s role in my practice is to ensure that patients are well informed and supported as she follows them through their treatment. She also works collaboratively to coordinate care across the different treatment types, a more complicated process than most people realise. Many head and neck cancer patients require a combination of surgery, radiotherapy, chemotherapy and more recently immunotherapy. In order to help support patients through their treatment and improve their long term outcomes Lisa also ensures patients are referred to a range of other clinicians. These include speech pathologists, dietitians, specialist physiotherapists, oncology psychologists, and maxillofacial prosthodontists who make prostheses to improve cosmetic outcomes. Helping patients and carers manage this regimen and coordinating appointments, especially for our regional and rural patients, is an important part of Lisa’s role.

Lisa also provides an additional point of contact in my practice for patients and carers. They no longer have to wait for me to return their messages in order to be informed of normal scan results or to chase up system failures in the process of their treatment. Plus they have the reassurance of knowing there is another clinician in my practice who has an overview of their entire treatment process.

Lisa meets patients at their first consultation. She assists me in the consult, attends the Head and Neck Multidisciplinary Care Meeting, rounds on patients in St Vincent’s Private, and answers multiple questions from patients and carers by phone and email. Lisa is also in charge of our patient and carer support materials. She is currently reviewing all our literature to ensure we do a better job of effectively communicating appropriate information to patients and carers at a time and in a manner which suits their individual needs.

Lisa has been a registered nurse since 1993 and has worked extensively in critical care. She completed a Master of Nursing (Nurse Practitioner) in 2016 and is a member of the Australian College of Nurse Practitioners. Lisa is a fantastic addition to the practice. She has extensive experience and a tremendous commitment to the clinical and psychosocial care of patients. I continue to be amazed by her limitless empathy and patience. Plus she has an enormously calming effect on everyone around her. Lisa is much loved across the St Vincent’s campus, especially in Intensive Care.

More clinical expertise means better patient support

In 2019 the Australian Cancer Council endorsed a document created by Victorian head and neck cancer specialists called ‘Optimal care pathway for people with head and neck cancers‘. This important paper acknowledges that in the past two decades, the number of people surviving head and neck cancer has increased; patients receiving treatment for head and neck cancer have a high survival rate relative to other cancers. It also describes the difficult and persisting side effects most patients experience beyond treatment.

As a busy surgical oncologist I spend my life prioritising decisions and actions according to clinical need. Unsurprisingly this has meant that patients in acute treatment commandeer most of my attention. By adding Brett and Lisa to my clinical team I am injecting more resources, experience and expertise into my practice. Our goal is to use these resources to meet the urgent clinical demands of a growing number of head and neck cancer patients and to provide better quality of life focussed support to a growing population of cancer survivors.