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Bowel cancer care: a day in the life of colorectal nursing teams

As COVID pressures continue and NHS oncology services tackle huge waiting lists, clinical nurse specialists and consultant nurses share the highs and lows of the job

As COVID pressures continue and NHS oncology services tackle huge waiting lists, clinical nurse specialists and consultant nurses share the highs and lows of the job

  • Video calls have become a routine part of care in the pandemic, but a return to face-to-face clinics offers a chance to ‘reconnect’ with patients
  • A typical day could involve support group meetings, clinical care, helping out on the wards, and managing referrals and phone calls from patients
  • How team members cope with the emotional aspect of caring for people who have received a cancer diagnosis, and their families

Around 43,000 people are diagnosed with

As COVID pressures continue and NHS oncology services tackle huge waiting lists, clinical nurse specialists and consultant nurses share the highs and lows of the job

  • Video calls have become a routine part of care in the pandemic, but a return to face-to-face clinics offers a chance to ‘reconnect’ with patients
  • A typical day could involve support group meetings, clinical care, helping out on the wards, and managing referrals and phone calls from patients
  • How team members cope with the emotional aspect of caring for people who have received a cancer diagnosis, and their families
Face-to-face clinics are back, allowing staff to support patients more fully Picture: iStock

Around 43,000 people are diagnosed with bowel cancer in the UK each year and it is the country’s fourth most common cancer.

As pandemic pressures continue to affect NHS services, three nurses working in colorectal oncology services share their accounts of a typical day two years after COVID-19 changed everything.


A chance to connect with patients face to face again

Joanna Thomson, a lower gastrointestinal oncology clinical nurse specialist (CNS) at Guy’s and St Thomas’ NHS Foundation Trust in London

Joanna Thomson
Joanna Thomson

7am I start early to try to avoid morning rush on the tube – when COVID restrictions ease, it gets busier. As I’m one of the few people on the tube wearing a mask, I’m conscious of the risks to our patients of travelling when it’s busy.

9am I join the virtual board round – a discussion of patients’ journeys. We discuss existing gastrointestinal (GI) oncology inpatients and those who have been admitted overnight, to check whether our team can offer support on the wards. There is a mix of patients to see: a new admission, an acutely unwell patient, some exhibiting challenging behaviours and one with a discharge complication. I go up to the ward to see if we can help.

10am Once finished, I tackle our ever-growing inbox with my colleague. How it reaccumulates so fast overnight always fascinates me. I’m grateful every day that there are two of us in the colorectal cancer team. Our tasks to respond to include new referrals, patients with treatment questions and symptom concerns, missing medications, appointment queries, and the current favourite – a positive COVID-19 result. We divide and conquer as many of these as we can.

12pm I head to the oncology ward, instantly reminded of the daily challenges there in balancing complex patients with ongoing staff shortages. Speaking to the nurse in charge, I sense relief that they can hand over responsibility of some of the patients to us for a short time. After a quick handover, I don the personal protective equipment (PPE) and head into the bay. I spend some time with each patient and make a to-do list of follow-ups.

1.30pm Time for a quick pre-clinic meeting between the clinical nurse specialists, consultants and clinical fellows to highlight any concerns, plan who will see who, and discuss our six new patients.

2pm Clinic starts. There aren’t enough rooms in the department for all the doctors to start at once, so we decide who will see the first few patients face to face and who will get on with calls. While these patients are being seen, it’s a great opportunity for me to inhale some lunch.

‘COVID has taken away so much of our ability to communicate with patients on a more sensitive level. Virtual calls and emails don’t have the same empathetic effect as sitting face to face’

Joanna Thomson

New patients have their initial consultation with the consultant, where they go over their diagnosis, staging, prognosis (should they want to know) and the treatment plan. A GI oncology CNS then meets them in a separate room to offer them time to breathe, digest and ask questions. We explain the various support services available and practical things such as hospital transport and, importantly for them – as it is difficult at this stage for people to really take in information – we give them a contact sheet with our details.

Virtual meetings have got us through the pandemic, but don’t allow the same level of communication Picture: iStock

Today I sit in with a patient who has come to his appointment alone, and has been told his only options for treatment are palliative. He is not expecting this news. Unfortunately, in our world this is a fairly common scenario, though not one that ever gets easier to witness. He wanted to know his prognosis but it comes as a huge shock. The consultation is stopped there and I take him into a quiet room accompanied by another CNS that he knows well. Instead of giving him all the usual information, we just give him our contact details and agree to speak again tomorrow.

7pm Although I finish late, clinic is the part of the job I love the most – where we get to see the patients, reassure them and try to solve problems. COVID has taken away so much of our ability to communicate with patients on a more sensitive level. Virtual calls and emails don’t have the same empathetic effect as sitting face to face. Clinic gives us this time to be able to reconnect and provide the support we went into this job to provide.


I feel I’ve made a difference and have one of the best jobs there is

Nicola Tonks, colorectal consultant nurse at the Royal Wolverhampton NHS Trust

Nicola Tonks
Nicola Tonks

7.30am Monday morning. I check whether any patients were added to the clinic late on Friday, then review all our colorectal clinics, our inpatient list and the list of patients who will be admitted for theatre this week. Then I check our phone support line for any messages left over the weekend and reply to urgent emails. I’m hoping the phone doesn’t ring just yet; if it does, there’s a chance it will be one of the team unable to come to work because of a positive lateral flow test. Everything feels precarious with COVID-19 cases on the rise.

9am Thankfully the whole team is in today, and we finish our handover. This is an important hour as it’s an opportunity to draw on each other’s expertise and experience and discuss any patient care issues. It’s going to be a busy week. Increasing numbers of patients are being referred to the colorectal cancer fast-track triage clinic with bowel cancer symptoms, or receiving a colorectal cancer diagnosis at a more advanced stage, compared with before the pandemic.

9.30am There are more messages from the support line. One recently discharged patient has concerns about leakage from his rectum and redness around his parastomal skin area. I listen to his concerns and hear how he and his wife are coping since he returned home, then arrange a virtual clinic appointment for him at midday. Video consultations have been one of the positive changes in care since the pandemic, helping us to respond quickly to problems.

10am I have two patients to see in clinic. The first has been through the bowel cancer screening service and diagnosed with rectal cancer. The agreed plan is to offer him preoperative chemoradiotherapy with an anterior resection. I’m glad to see that he is accompanied by his wife at the appointment. His surgeon and I discuss his diagnosis, treatment options and next steps with them. I never underestimate the potential psychological impact a cancer diagnosis can have. I arrange to phone him to provide some ongoing support.

‘I think about how difficult it has been during the past two years for patients who have had to attend appointments alone, or have been unable to see their family while in hospital’

Nicola Tonks

My next patient has completed her chemoradiotherapy course and is ready for surgery. It’s good news in terms of the cancer responding to treatment, but she needs an abdominoperineal resection, which will mean a permanent colostomy. She is aware of this from earlier discussions about the impact of surgery and life with a stoma. Although keen to get on with the surgery to ‘get the cancer out of her’, she’s worried about the psychosexual aspect of living with a stoma. We arrange a further counselling session.

12.20pm I pop up to the ward to see a patient who underwent a reversal of his stoma on Friday, and who’s going home today. We discuss his bowel function and management, and continued support. Our support worker updates me on the patients she has seen and their progress towards managing their stoma independently.

1pm I take a sandwich back to the office ready for a Teams meeting about identifying any potential psychological harm caused by delays in treatment.

2pm I check the team is getting on okay, answer queries about referrals and schedule some appointments for patients with symptoms of low anterior resection syndrome.

3pm I prepare for our patient support group meeting and think about how difficult it has been during the past two years for patients who have had to attend appointments alone, or have been unable to see their family while in hospital. I’ll be glad to recommence face-to-face support group meetings, but for now we have video calls and it’s good to be able to connect.

5pm The end of another rewarding day, which leaves me feeling that I’ve made a difference and have one of the best jobs there is. Time to head to the gym for a swim.

RCNi Learning module: Effective nurse-led approaches to reduce colorectal cancer

It’s great to have critical care provision back – and we hope it stays

Claire Taylor, Macmillan nurse consultant in colorectal cancer at St Mark's Hospital, part of London North West University Healthcare NHS Trust

Claire Taylor

7.30am The day starts with listening to a grand round presentation online, where conditions and treatments are presented to an audience of clinicians and students for learning purposes – an important part of our in-house education, which covers a wide range of colorectal research. St Mark’s is the only hospital in the world to specialise entirely in intestinal and colorectal medicine, so we talk a lot about bowels here.

8.15am Quick catch up with the Macmillan colorectal CNS team. We carry our own caseload, but share some patients with this team, so it’s important to discuss their clinical care and ensure consistent messaging and goals.

9am I return calls to three people who left messages on our helpline, seeking updates on their care, pathway support and symptom advice. I primarily look after patients with locally advanced and recurrent disease who are referred into our complex cancer clinic. This is a specialist service, and most patients live out of area, so we rely on email, phone and video communication to keep in touch.

11am Ward meeting to discuss discharging a young woman who has had palliative surgery for an extensive colonic cancer with peritoneal metastases. Her symptom control is much improved, but she needs a lot of support from the palliative care team, the stoma care nurses, the rehabilitation unit, the Macmillan clinical psychologist and the physiotherapist and occupational therapist. I value working in a team with a strong multidisciplinary approach to patient care. It’s vital we combine our expertise and skills, and work closely with this patient’s family and the community healthcare providers if we are to get her home.

‘At any one time my CNS colleague and I are supporting and tracking about 100 patients before surgical management, while also managing and monitoring aftercare’

Claire Taylor

12pm We start our complex cancer clinic. I’ve booked in five patients who each receive a 45-minute multidisciplinary consultation, either via video or in person. The first patient is a man in his forties shocked to hear the extent of the surgery being offered to achieve curative treatment of his rectal cancer. He will need a lot of support to help prepare him emotionally and physically, if he chooses to go ahead. I will be a key contact person for him, identifying his holistic needs, giving him information and support, and working with his referring team. On average, we have 40 interventions with each patient and our relationship often extends over many months, if not years. The next patient, a woman in her late seventies, swims every day and takes no medication, so feels she will cope well with major surgery. I refer her to our prehabilitation service.

I am responsible for organising the three complex cancer clinic surgical lists we have each week, which involves considerable coordination. Two of the lists allow for extended theatre operating and have intensive care unit provision, so it’s essential we use these resources safely and effectively. During the pandemic we had many months without critical care provision on site, and the whole team is grateful to have this back. I just hope further COVID-19 surges don’t affect our patients accessing timely cancer surgery.

4pm Late lunch on my own in the office to reflect and recharge.

4.30pm I work through some of the many emails that come in each day from colleagues, patients and professional bodies. The email workload can feel onerous, so efficient management is required. At any one time, my CNS colleague and I are supporting and tracking about 100 patients before surgical management, while also managing and monitoring aftercare.

6pm My final job for the day is to try to find some more participants for two studies that I am recruiting to. I never finish all that I plan to do each day, so several activities get added to my diary for tomorrow’s ‘to-do’ list.


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