Enhancing the radiotherapy experience

We're joined by Nicki Ingram, a clinical specialist radiographer, to talk about the ways the radiotherapy team at Weston Park use funding from the charity to make the patient experience as good as possible.

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Ruby Osborn: Hello and welcome to the Weston Park Cancer Charity Podcast, sharing stories about our work, what we do and the people we support. From funding life-saving research to providing practical help and emotional support, it's our job to care in every sense for our patients and their families. Today, we’re hearing about some of the ways our funding helps to support patients in the radiotherapy department.

Nicki Ingram: So I’m Nicki Ingram, I’m Clinical Specialist Radiographer for Patient Information, Children and Young People. I’m trained as a therapeutic radiographer, I’ve been qualified for 32 years, worked at Weston Park now for 22 years, but I did actually train here back in the late 80s. Worked briefly in Cambridge and then for 10 years at Leeds in their radiotherapy department, came back to Weston Park, worked as a clinical radiographer in the treatment sets, specialised a little bit in patient review. And then 10 years ago this job came up and I decided it was something that I think I would enjoy, because there’s not many jobs that you can have where you’re rolling about on the floor with a child playing games or hide-and-seek or getting dressing in a unicorn onesie.

One of the big changes from when I first qualified, even in training, was that there’s a lot more support there for patients within the actual clinical environment. A lot of patients, used to just have patients who had breast cancer had breast care nurses and that was it really. Now all the tumour sites have clinical nurse specialists attached to them. So they’ve got support there from day one, rather than just talking to a doctor, and the change in that as well is that patient care isn’t just based on what a surgeon thinks or what a medical oncologist thinks or a clinical oncologist, it’s a team decision, and within that team you also have the clinical nurse specialists and any specialist radiographers, anybody really that’s involved in the care. That’s the main thing I’ve seen, and that’s just even changed over the last 10 years since I’ve been in this job.

Obviously having worked in the NHS, there are limited funding, we don’t always get everything that you would love to have for a patient. And having something like Weston Park Cancer Charity to help just add those little tweaks at the end, those little things that just make that improvement in patient care, is obviously invaluable having that there. And I know the charity don’t just fund the little things, they also do the big things and they’ve funded posts, they’ve funded study, and they still do help with study costs if needs be, so it’s not just about the little things, but I think the little things make the most difference.

Ruby: With children, are there any extra challenges compared to adult patients you have to work around?

Nicki: The children, obviously we treat from age of zero to 16, classed as children. Every single child is different, every single child age range – you can have a three-year-old that’s very independent, you can have a three-year-old that’s very clingy. You can have an 11-year-old that’s very clingy. You can have a 16-year-old that doesn’t like separation from their parents, that is very anxious about what’s happening. Every single child is so unbelievably different, every single family situation, the support that they get, how their parents are dealing with the situation as well because it’s not just the patient, it’s the whole family around them, because that child won’t come without their family. It’s so very different to an adult.

Plus, so we’re not really set up for treating children. We do our best to make it as child friendly as possible but the minute they walk in the hospital it’s not full of other children, it’s full of adults. And also actually having the treatment, it’s something different, it’s something that they’ve never really experienced before, and they do have to be in a room on their own. Their parents cannot be in the treatment room with them, so we have to work round that as well, we have to have practice sessions, we have to maybe have little treats, we use the intercom, we use music, we use a ribbon that the child holds on to one end inside the room and the parent holds onto the ribbon outside the room, and just by tugging that ribbon the parents and the child feel connected.

So there’s lots of little things. I’ve read so many stories over the intercom, I’ve pretended to be Peppa Pig, aunties come in and sing songs, we’ve had Uncle Steve come in because that was the only person that could get a child to lie still. It’s very different, no child has ever been the same, so every child is a challenge just until you know what works for that child.

So the biggest impact from the charity has been with the children, the paediatric service. Before I came into post, we had a team of radiographers that used to look after the children, but when a child finished treatment it was the radiographers on the treatment machine that would put together to buy the child a present, and it’d depend on who the staff were as to what they got and how much was spent. But when I came into post it felt right that we needed to look after them equally and a little bit more consistently, so we put in for a grant from the charity and we got a fund where we could access money so every child that finished their radiotherapy were brought a present as a “well done, you’ve finished your treatment.”

But we also used it for things like if they were on treatment during their birthday so we could make a little bit of fuss over their birthdays, leading up to Christmas, leading up to Easter. Anything just to try and, you know, if they’re coming for treatment, it’s not nice to come on your birthday, why not make it a bit of a treat, get them a cake, get them some balloons, put a few bits of bunting up, buy them a little bit of a present.

We also used it to buy arts and crafts materials so we could decorate the masks that they might have to wear during treatment. And also, some of the children, not all, but some of the children, they need even more encouragement. So it might be that we have to give them a little bit of a treat every day. So we could do that because we had the funds, and it made it easier to get the children through treatment, a little bit more enjoyable for them because we were spoiling them a little bit more. We’d got toys and games within department that they could play with while they were waiting – sometimes it was a drag to get them away from the toys to give them their treatment. But it really helped, it’s really been a good thing that we can do that now for all our children.

Ruby: And so for people who aren’t familiar with – you talked about the masks, but it’s not like a face mask like we’ve been wearing through the pandemic, it’s a different kind of mask, isn’t it.

Nicki: No, so it’s made of almost like a plastic. It starts off as a sheet, but when you warm it up you can mould it to your face. It’s a strange feeling, it’s like having a wet flannel over your face, a wet warm flannel, but it only takes five minutes, if that. As it gets cool again, it dries and sets, so it’s the same shape as that person. It keeps them in position, it attaches to a frame on the bed, and it just makes sure that they can keep their head in the still position.

Because if you imagine a slightest movement of your head can take things out of the treatment field that need treating, but also bring things into the treatment field that don’t need treating, like eyes, parts of the brain, glands within the head, that don’t want treatment. And the slightest movement of a head, as I say, it can make a big difference in the accuracy of the treatment.

Plus also, we need to know that we’re treating the same bit every day. When it’s on a part of a person’s body, we can actually put a permanent onto the skin. We can’t do that on someone’s face, we can’t put little tiny permanent tattoo dot on someone’s face, it’d be so unfair to put a penmark onto their face. So if they’ve actually got a mask that’s theirs, you can put it onto their mask. Bear in mind this mask has got lots of little holes in, it’s not just one sheet of plastic. They can, it’s breathable, they can breath through it, we can actually cut out the nose and the eyes and the mouth if needs be to make it more comfortable.

And what we do with them, decorating them, we can decorate them to suit that child. So we’ve had one that’s been decorated to look like Harry Potter, we’ve had unicorns, we’ve had wrestling masks, we’ve had a zombie. The zombie was amazing, it had like a detachable eye. And one things as well, we had a little girl who was absolutely mad on unicorns, so they made us all on the treatment machines, all the radiographers, headbands with little unicorn horns on, so when she came for treatment we were all dressed as unicorns. Just little things like that, it does make the difference.

Ruby: Could you tell us a bit more about the sticker charts?

Nicki: Oh yes, yeah, so the sticker charts as well. It’s a reward, at the beginning of their treatment I create a sticker chart for them which has a little box for each treatment that they’re having, it’s got their name on, it’s got characters or things that they like on it, so it’s personalised to them. And we then can, using the grant from the charity,  we can purchase stickers relevant to each child. So if this child likes Peppa Pig we can buy Peppa Pig stickers, if they like motorbikes we can buy motorbike stickers. And each day that child can put a sticker on, or more than one if they’re cheeky, and at the end of their treatment, it’s “yay, I’ve finished, I’ve completed y sticker chart,” they can take it home, there it is as a reminder that you did that, you got through that treatment. And again it’s just personalising the treatment for the children.

And to be honest we have used it for the odd adult as well. We have had some adults that have had learning difficulties or disabilities, and we’ve realised actually what we do for the children works for the adults as well, and we’ve had sticker charts for them, we’ve painted their masks, we’ve used a ribbon. So we’ve used all the things that we would use for children, all helped by the funding from the charity, for some adults as well. So it works well.

Ruby: And there’s also the book that has recently been produced.

Nicki: Oh, Teddy’s Book, that’s fantastic. We used to have a photobook where it showed a child in department having their mask made and a picture of a treatment machine and a picture of the CT scanner and a picture of the treatment masks and things. But one of the medical physics technicians, Carin, she came up with a fantastic idea of using the teddies that all the children get when they start their treatment down at the Children’s. and in the past we’d had one of the teddies and they’d had a mask made, and it was kinda like, “oh, that works quite well, we could show how Teddy has his mask made and how Teddy has his treatment.” And it’s a really useful book because all the children get one of these teddies. So the fact that we can actually have Teddy with a mask for treatment and show that journey that they’re going to have, amazing, excellent idea, so simple yet very effective and it’s lovely that we can use it.

The charity have helped us in lots of ways just to make the environment nicer for patients, including the fish tank in the main waiting area, which the children are attracted to as well, as we get some of the children help us feed the fish, but I think for everybody, everyone finds watching fish relaxing. So just again, it’s just something very simple, not terribly expensive but it makes a big difference.

Along with the fish tank we’ve had TV screens within the department for distraction almost but also to provide information for patients about the services that the cancer support provide and the charity, but also information about the treatment. And a news channels that then just distracts them while they’re sat there waiting for treatment.

We used to hold radiotherapy open nights and we’re hoping to restart those again soon, which is where patients were invited to come and actually have a look round the department, see a treatment machine, well just visit the department, see the parking, see how to get into the department, meet the radiographers, ask questions, also meet staff from the support team, cancer support team, just to introduce them to radiotherapy, give them the chance to ask those questions. And the charity have very kindly provided refreshments for that nights, just again, just something simple, something not terribly expensive but effective, that it made the patients comfortable when they came in they offered a cup of tea, coffee, drink, sit down, have a chat and then we show them the treatment machines and answer any questions they might have. So again, something very simple but effective.

You want every patient’s experience to be as the best it can possibly be. I think people can be scared of Weston Park. It’s, you know, the generations in the past have said “oh it’s a cancer hospital, big C,” there’s lots of fear around Weston Park. I think it’s changing, it’s definitely changed, but there’s still, you know, cancer is still a scary thing for I would imagine every patient. But if we can get them through treatment comfortably, as nice an experience as possible, support them in the best ways we can, then that it what you want. You want every patient to have the best experience.

Ruby: Thank you for listening to this episode of the Weston Park Cancer Charity Podcast. To find out how you can help us to keep supporting work like this, visit our website, www.westonpark.org.uk, or give us a call on 0114 553 3330.

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