Oncology was interesting, but the main issue during the week was the overworked state of the dietitians. They obviously cannot control the number of people who are referred to the department, and must see new referrals within 2 days, but they must also review existing patients according to a system of priorities. Last week, with holidays and lieu time off, there weren't enough people to cover, especially when slowed down by two students tagging along and getting in the way.
The different dietitians manage this state of stress in different ways, but let's just say I didn't have a great week. There were some highlights, though, and I completed three supervised consultations, which is quite an achievement. One patient also agreed to be my case study. I am now half way through this placement, and surviving. I will be very glad when it is over.
The most interesting aspect of the week in cancer was finding out how radiotherapy in the Head and Neck department is managed. A multidisciplinary team (MDT) reviews the scans and history with a surgeon, chemotherapist, radiotherapist, radiographer, clinical specialist nurse and others, and devise a plan of action: radical or palliative surgery, chemo or radiotherapy. I have observed two of these meetings, and the quality of the online scans (projected onto a screen) and the interpretation of them is a wonder to behold.
The team then sees the patients and explains the clinical situation and their proposed treatment, and the patient is asked to consent. If radiotherapy is to take place, the next step is to construct a mask to go over the head and chest to immobilise the patient while treatment is delivered, to ensure exact targeting to the tumour. The mask starts off flat with small holes, is put in a warm bath for three minutes which softens it to the texture of soft chewing gum. When it is then placed over the patient, the plastic stretches and the holes expand to a wide mesh as it is moulded to the exact shape of the face, neck and chest, as it hardens.
The whole process of making the mask took about an hour, then the completed mask and patient move to a different room where the mask is marked up very accurately and a CT scan done so that the treatment can be planned very precisely in relation to the reference points on the mask.
The role of the dietitian in oncology of Head and Neck is vital, because most people will have trouble eating at some point - either because the site of the tumour encroaches vital spaces (e.g. the mouth or oesophagus), or because of the effects of the treatment. Both chemotherapy and radiotherapy produce unpleasant gastro-intestinal symptoms: nausea, vomiting, loss of appetite, and often inflammation in mouth and oesophagus (mucositis). It is important to try to maintain the nutritional status of the patient, not only because it will help recovery if enough nutrients are available to the body, but also so the mask fits. If someone loses a lot of weight, the mask may become loose and have to be re-done, because accuracy of positioning within the treatment field is crucial.
The routine of mainly one specialty area per week is about to be broken as the obesity dietitian is away for my obesity week - but that will give me time to work on the presentation and the case study that I need to prepare.