Secondary Breast Cancer

Lisa Cameron Excerpts

Wednesday 21st October 2015 Westminster Hall

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

It is a pleasure to speak under your chairmanship, Ms Dorries. I congratulate the hon. Member for North Warwickshire (Craig Tracey) on securing this extremely important debate. I refer Members to my entry in the Register of Members’ Financial Interests, having worked as a clinical psychologist in the NHS for 20 years.

A diagnosis of secondary breast cancer means that the cancer can be treated but not cured. In those cases, the aim of treatment is to control and slow down the spread of the disease, to relieve symptoms and to give the person the best possible quality of life for as long as possible. At present, there are many treatments that can keep the cancer under control, often for many years. However, when it comes to breast cancer, it appears that the focus has overwhelmingly been on primary breast cancer, and there has been a lack of awareness of and attention to secondary breast cancer. This is therefore an extremely important debate, particularly as this month is Breast Cancer Awareness Month.

There appear to be real problems with equity of care across the country. While there are examples of good practice, it appears that quality of care can depend upon location, and that people with secondary breast cancer often receive inadequate care. Access to a clinical nurse specialist from the point of diagnosis onwards has been highlighted as an extremely important development, as has a multidisciplinary team approach to people’s care.

I would like to highlight the relevance of continuity of care between hospital and community services, alongside timely information on all aspects of treatment and care for patients. Access to information, as has been described, about both local and national services is crucial, as well as access to expertise in palliative care for symptom control and ongoing management of troublesome symptoms. It is important that support is provided for the partners, families and children of patients, and I hope the Minister will comment on that in her response. Access to appropriate treatments is also important, as is being made aware of the availability of local clinical trials that may be pertinent.

There has to be a regular assessment of patients’ emotional wellbeing and access to an appropriate level of psychological support. That support should be available whenever needed by the patient, particularly at diagnosis, when cancer progresses and at the end of each treatment. I am aware that Breast Cancer Now has highlighted the huge emotional toll for women living with secondary breast cancer in terms of the anxiety and uncertainty of having to go for regular scanning to monitor their condition. In a video on Breast Cancer Now’s website, one patient describes her experience of going for scanning every three months and then having to wait two weeks to find out the result. During that period, she describes experiencing “scan anxiety” about the potential outcome. Before getting the results, she mentally prepares herself to expect the worst, so as not to be disappointed. She describes crying due to the emotional stress, even when the news is good, and then going away to live her life for another two months before having to start the cycle again.

I am aware of three important articles in The Lancet from 2014 that looked at the prevalence of depression and mental health problems in oncology patients, including those with secondary cancer, the majority of whom were receiving no form of treatment for their mental health difficulties. The recovery from and management of physical conditions is aided by people having good mental health and wellbeing, and that is corroborated by NICE guidance from 2009. There is therefore a need for greater access to psychological therapy provided by the NHS, which has often been inadequate. There should be increased training for clinical nurse specialists in psychological modes of therapy such as cognitive behavioural therapy, so that they can directly assist patients. Greater parity between physical and mental health services is key, alongside greater integration of those services for patients who have a dual diagnosis.

Mental Health (Armed Forces Veterans)

Lisa Cameron Excerpts

Wednesday 14th October 2015 Commons Chamber

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I am pleased to have secured this important debate. Let me initially declare an interest, having previously worked in the NHS with trauma clients, some of whom have been veterans. Also, my husband is a veteran, having served in the Army, including in Bosnia.

The majority of British military personnel do not experience mental health problems while in service or afterwards in civilian life. For a significant minority, however, this transition is brought to the point of failure by mental health issues that range in complexity and severity, and are caused by factors before, during and after military service.

Although the mental health problems experienced by military personnel are the same as those suffered by the general population, the unique risk and experiences faced during service and the transition to civilian life mean that their mental ill health may be triggered by different factors and involve unique complexities.

Service personnel may experience trauma from a variety of situations, such as training incidents, administering medical treatment or other activities in war zones. However, studies in this area have suggested that some groups of service personnel, such as deployed reservists and early service leavers, may be at higher risk from mental health problems.

In 2011, the Ministry of Defence published the tri-service armed forces covenant. The principles underpinning it are that members of the armed forces community should not be disadvantaged by their service and should be provided with specialist treatment where appropriate and based on clinical need. It is important to ensure that there are no gaps in those service provisions.

A report by the Mental Health Foundation commissioned by the Forces in Mind Trust and published in 2013 conducted a comprehensive review of the available literature. It reported that the overall prevalence of mental health problems in the UK armed forces remained fairly stable between 2000 and 2010. It particularly highlighted depression and anxiety disorders as the most common mental health problem among both serving and ex-service personnel, while post-traumatic stress disorder was found to be associated with being a deployed reservist and with individuals experiencing problems at home both during and following deployment. Emerging evidence has also confirmed the existence of delayed onset of PTSD, with one study reporting a prevalence of 3.5%.

[Rebecca Pow (Taunton Deane) (Con)]

I spoke today to a charity called Go Commando in Taunton Deane, where I come from. It reported exactly what the hon. Lady is saying—that many of the servicemen and women who served in Afghanistan have settled back home, but are now showing many signs of post-traumatic stress disorder and depression, and of requiring anger management. I support the hon. Lady in urging as much support as possible for these people, some of whom have served as long ago as in Bosnia or even in the Falklands.

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[Dr Cameron]

I thank the hon. Lady for her intervention, and I concur exactly with her sentiments.

From speaking to an ex-military medical officer in preparation for this debate, it appears that some hold the view that the prevalence of PTSD is much higher than acknowledged. Studies also found that the suicide rate was higher than expected for those under the age of 20, and that there was a two to three times higher risk of suicide in men aged 24 or under who have left the armed forces as compared with their counterparts in the general population and those still serving.

It is also recognised that alcohol misuse among UK military personnel is a significant health concern. I understand from Combat Stress that that presents as a significant issue among the clients with whom it works. It describes issues related to the culture of alcohol use in the forces, and the use of substances as a maladaptive coping strategy to manage symptoms of mental health problems.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on raising this matter. Everyone who is in the Chamber tonight is here for a purpose, because we have constituents who suffer from this condition. His Royal Highness Prince Harry said recently that we needed to do more to help those with what he described as unseen injuries. Only by talking about this and helping more can we make the necessary changes.

I want to make a brief point about people who live in the Republic of Ireland but served in the British forces. Some of those people are not receiving the help that they should be receiving, financially and in terms of benefits relating to mental issues and disabilities. For the record, will the hon. Lady ask the Minister to look into that?

[Dr Cameron]

I thank the hon. Gentleman. I should be pleased if the Minister would comment on those matters, which are very specific to Northern Ireland.

Problems arising in the current system appear to relate to a number of issues, including help-seeking, referral, assessment, and access to appropriate treatments. One study reported that only a quarter of those with diagnosed mental health problems had accessed medical help. It has also been reported that stigma and lack of trust or confidence in providers of mental health services represent some of the main barriers preventing service personnel and veterans from seeking help. Stigma concerning mental health problems is particularly problematic for military forces who are required to be physically and psychologically resilient. It has been emphasised to me that the attitudes of the Ministry of Defence are also important in that regard, and that there is a need to be upfront in acknowledging the mental health issues that can arise from military service, as well as the physical risks, in order to prevent such barriers.

[Kirsten Oswald (East Renfrewshire) (SNP)]

I wonder whether my hon. Friend is aware of reports of drone pilots experiencing higher levels of post-traumatic stress disorder than those flying conventional aircraft. Issues of stress are causing some concern, and questions relating to recruitment and retention are beginning to emerge. Will my hon. Friend join me in urging the Minister to commit himself to more research and support for service personnel and veterans in that context?

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[Dr Cameron]

I thank my hon. Friend for a very well-made point. I certainly urge the Minister to commit himself to research on that issue.

In the context of referral and assessment, it has been suggested that there are still problems caused by a lack of understanding and awareness among many mainstream health care professionals of how to deal with the issues that veterans present. There is a tendency to rely on prescribing medication, and, according to Combat Stress, there is a problem of low rates of referral to its service by GPs and community mental health teams. The British Medical Association has drawn attention to the chronic undermanning of Defence Medical Services, which is reported to have had a detrimental effect on morale, motivation, and the retention of doctors. The association says that adequate resources are a key factor in ensuring the best quality and consistency of mental health care in the long term. It believes that the issue should be addressed as a matter of urgency, given the need for appropriate and sustained long-term funding.

The Royal College of Psychiatrists has highlighted the need for better trauma-related treatment from the NHS. It reports that many veterans rely on small charitable providers that sometimes do not have the resources to be trained in evidence-based therapies, which should be consistent with the current evidence-based practice. The Royal College has also raised the need to evaluate the effectiveness of current follow-up service. The Murrison report recommended a telephone or face-to-face check on how someone was doing a year after they had left service. Currently, however, all that happens is that a letter is sent to the last known address of the service leaver, telling them that they can phone or see their GP if they have an issue. It is suggested that there may be a need for investigation into the uptake of this service and whether this correspondence is in fact being received.

The Government therefore need to address issues of help-seeking, stigma, referral processes, assessments and availability of appropriate treatments. There are also issues of co-morbidity and the requirement for integrated approaches across services including health, criminal justice, forces and social care. There is, in addition, a reported lack of service provision for partners and children of service personnel, who may also suffer mental health issues owing to the nature of their family member’s job. I am pleased that the Scottish Government have put in place a veterans commissioner for Scotland to begin to address some of these issues, but I would like to see similar credence given across the rest of the UK.

[Kit Malthouse (North West Hampshire) (Con)]

I congratulate the hon. Lady on securing this debate on such an important subject. I have Army headquarters in my constituency and strong services links in Hampshire. So desperate were a group of veterans in my constituency that they started their own organisation, Veterans in Action, who have just this month launched PTSD awareness month. I am wearing their little badge, which looks not dissimilar to an SNP badge, I have been told. The hon. Lady put her finger on the problem earlier in her speech when she said that there is not enough awareness out there about these issues, particularly among medical staff. I hope, therefore, that she might support an initiative such as awareness month in the future.

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[Dr Cameron]

I do indeed support awareness month, and I very much like the hon. Gentleman’s wee badge.

To conclude, veterans are individuals who would have put their lives on the line for their country. The least we can do is prioritise their care and treatment to support them in their recovery. I welcome the Prime Minister’s comments today regarding prioritisation of this issue, and I welcome the Minister’s reply.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

I call the Minister, Alistair Burt.