GP Masterclass
A Case Study
Catherine Dale, RN, BSc Cancer Care
Macmillan Advanced Nurse Practitioner, Uro-Oncology
Heatherwood and Wexham Park NHS Foundation Trust
What am I talking about?
 Outline
and discuss the care of a patient with
prostate cancer from first GP appointment
 Highlight key events in the patients cancer
journey in secondary care
 Identify key points of ANP contact and
intervention with the patient and family
 Identify key points of GP/ANP
communication
 Highlight the key role the ANP has between
primary and secondary care
LUTS
Male Patient
Aged 55
Presents to GP
with........
PSA 30
Afro
Caribbean
DRE
nodule
left lobe
Family
history
prostate
cancer
Suspected Cancer Referral to local Urology MDT
Appointment with
Urologist and ANP
MRI Pelvis - neg
Bone Scan - neg
TRUS and Biopsy
Shows Gleason
4+4=8 adenocarcioma
of prostate
Local and Specialist
MDT discussion
Multi-modality
treatment
Breaking bad news and
decision making
Over a couple of weeks
Joint Clinic
Urologist, Oncologist &
ANP
Inform GP of
diagnosis via fax
by end of next
working day
Complete holistic
assessment of
patient & care plan
Issue information
prescription
The ANP will.......................
Issue prescription
charge exemption
certificate
Radical
Prostatectomy
Supersensitive PSA
rise
OPA with Oncologist
& ANP
Plan for prostate
bed radiotherapy
Supersensitive PSA
rise commenced on
maximum androgen
blockade
Discharged for PSA
monitoring aware
will need to be
referred when PSA
rising
Review patient on
ward and fax a copy
of patient End of
Treatment Summary
to GP
Support patient and
make MDT referrals
for ED & urinary
incontinence
Complete further
information
prescriptions on
treatment and side
effects
The ANP will.......................
Complete further
holistic assessments
and care plan
Supersensitive PSA
rise
GP refers back to
oncology
Oncologist & ANP
appointment. Restaging scans show
bone mets
Offered second line
chemo but refused
as feeling too
unwell
Monitor patient in
nurse led outpatient
clinic
Holistic assessment
and information
prescription
Patients commences
six cycles of Docetaxol
chemotherapy Response then
Supersensitive PSA rise
Patients commences
Abiraterone –
Response then
supersensitive PSA
rise
Issue DS1500
certificate and assist
patient to apply for
this palliative
benefit
The ANP will.......................
Liaise with GP &
hospital consultants
to manage general
palliative symptoms
Patient now has uncontrolled cancer disease
•blood transfusion dependant
•Anorexia and weight loss
•Night sweats
•Bone pain
Only cancer control treatment low dose
steroid
Liaise with GP and
DN to transfer care
to primary care
Refer to community
palliative care team
for specialist
palliative care
The ANP will.......................
Support family in the
transfer of care back
to the community
LIAISON
LINK BETWEEN
HOSPITAL AND
PRIMARY
CARE
Advanced
EXPERT
CLINICAL
ADVICE
Nurse
Practitioner
SUPPORT
FOR
PATIENT
MAIN POINT
OF
CONTACT
Thank you!
Any Questions?