‘ consider the psychological problems , as sometimes patients can become depressed and very anxious that the tumour might return .’ Whilst psycho-social care was designed to be supportive , a further aspect was to increase patient resilience using various evidence-based interventions . Another component of aftercare that is often not acknowledged and absent she feels , is encouraging patients to adopt a more healthy lifestyle ; for example , stopping smoking or reducing alcohol intake . Continued support is also needed for those who might have had a complete removal of the larynx and are unable to speak . Despite improvements in voice prostheses that create a voice to the patient , the new voice will be different and this , too , can become a problem for patients and requires some degree of ongoing support .
Q How do you think the new guideline might change patient care
A She strongly believes feels that given differences in the level of care provided across Europe , the new guideline will ultimately allow clinicians to improve their practice . She saw it was necessary for the guideline group to include clinicians from across Europe to enable the collation and sharing of best practice . Whilst the importance of interventions such as smoking cessation being incorporated into aftercare were accepted , identifying the source of funding for these services was a potential barrier .
Professor Verdonck-de Leeuw recognised that there may be economic consequences associated with implementing the guideline . As she explained , ‘ in the short-term the cost for head and neck cancer care may increase and the question is whether the increased costs will occur at the hospital or can we refer patients to healthcare professionals outside of the hospital .’
A further uncertainty was ‘ whether the investment in optimal supportive care for cancer patients can decrease clinical costs such as a reduction in hospitalisation or GP visits .’ Nevertheless , she was hopeful that ‘ the investment in clinical care may well have a social impact , in that patients can return to work much earlier and achieve greater benefits in their social life .’ Despite the possible economic effects , she does believe that adherence to the new guideline will help to meet the majority of patients ’ needs .
The new guideline recommends that patients are seen approximately every two months in the first year after therapy , reducing to half yearly or annually later , although this schedule is somewhat dependent on the individual patient . She feels that one of the more positive effects of the COVID pandemic was that we learned that much of the workload of clinical staff could be
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We really need other kinds of support such as digital care , peer-support and self-management to improve so that , in the future , head and neck cancer care can be sustainable undertaken remotely . She added that although there was an initial reluctance on the part of clinicians to make greater use of digital technology , the pandemic meant that it was effectively non-negotiable but with hindsight , it seemed that the process worked well . Moving forwards , she feels that ‘ we can use digital care to improve , tailor and personalise the care that people need and will lead to much less unmet needs .’
Professor Verdonck-de Leeuw mentioned how her own centre is actively looking at the guideline recommendations to explore if the level of patient care can be improved , in particular , through greater use of digital care . Another aspect and which forms part of her current research , is if greater selfmanagement enables patients to better manage themselves . Although peer support is often vital for some patients , for others , the input of psychologists is unnecessary provided they have access to the necessary tools to self-manage more effectively .
Q With the guidelines now published , what are next steps ?
A Professor Verdonck-de Leeuw imagines that the first step is to learn about the impact of the guideline throughout Europe . Equally important is an assessment of the economic impact , as she explained ‘ we know that the healthcare resources will decrease and that the number of patients will increase and , while there is already a problem , this will be much bigger in the future . We really need other kinds of support such as digital care , peer-support and self-management to improve so that , in the future , head and neck cancer care can be sustainable .’
A further anticipated difficulty is that there is a lack of healthcare professionals required to deal with the likely increase in the number of patients requiring treatment and support . She believes sustainability will also be compromised by a higher number of patients visiting clinics , but this can be mitigated to some extent through more remote care . She also sees a benefit from tele-consultations in that they allows psychologists to see how and where people live , providing greater insight into patients ’ social circumstances .
In summary , Professor Verdonck-de Leeuw felt that the purpose of the guideline was to outline best practice care and to ensure that sufficient psycho-social support is in place . She also believes that immediate introduction of all the recommendations would be a daunting , possibly unnecessary , task for clinicians . She feels that a more pragmatic approach would be for centres to initially incorporate those recommendations that are easily achievable , building upon current practice , and assessing the impact and progressing gradually but with the ultimate goal of achieving full implementation in the future .