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.