I have worked within Head and Neck since I qualified in 2010. Having completed my final placement on the Head and Neck Surgery ward at UCLH, I quickly found myself drawn to this incredible patient group and was lucky enough to be given my first nursing job there. I enjoyed developing my knowledge of altered airway care and complex wound management, as well as developing my skills in holistic and psychological care for patients and their families. I was eventually seconded into the post of Deputy Sister for a year, before embarking on my first Macmillan junior CNS post in South Manchester in 2014. Here I looked after the OMFS cohort of patients and implemented a pre and post treatment HNA clinic. After a year, I returned to UCLH as a CNS, and was able to further develop my knowledge about oncological treatments for Head and Neck Cancers.

Working as part of a large CNS team, I also took on a role teaching Tracheostomy and Laryngectomy care as part of the Trust’s Altered Airway Study Day, and helped to pilot the Macmillan eHNA as part of a joint pre-treatment counselling clinic, run with dietician and SLT colleagues. In addition, I also helped to facilitate the Laryngectomy Club with my fellow SLT colleague, and together we supported the group to host a workshop for local GP practices, designed to educate them on the many changes that this patient group experience after laryngectomy surgery, and how they can best help to promote and maintain autonomy and  independence. In 2018, I was involved in a pilot project where the CNS team began triaging all neck lump referrals in a straight to test pathway, requesting US imaging to be done within a week of referral. Early results indicated that this reduced the length of time from referral to diagnosis (for both malignant and benign conditions) by approximately a week.

In Summer 2020, following a year of maternity leave, I undertook a new part-time role at Epsom and St Helier hospital as the first ever Head, Neck and Thyroid CNS for the trust, and I was able to build an entirely new service. This role also gave me the opportunity of experiencing the diagnostic pathway at a DGH instead of a big cancer centre as I had been used to. During my first week in post I was signed up to take part in a Quality Improvement project with NHSI/E, which was invaluable in helping me to gain a much more in-depth perspective on service implementation, quality improvement, as well as sustainability, and more importantly on making sure that services are co-produced with patient involvement. Eventually over the course of the year I was able to increase my hours by providing temporary cross cover to the Gynaecology service, and in August 2020 I took on the full time role of Lead CNS for Head, Neck and Thyroid, Lung and Gynae Oncology, managing a team of two gynae-onc CNS’s, three lung-onc CNS’s and a Macmillan Support Worker.

In June 2022, I launched a nurse-led telephone triage clinic, believed to be the first of its kind in the country. This meant triaging all new 2WW referrals for suspected Head and Neck Cancers (incorporating all larynx/pharynx, ear/nose/sinus, oral cavity, salivary and thyroid referrals) without bias from prior clinician triaging, using the stratified symptom-based risk calculator for Head and Neck Cancer. As the only Head and Neck CNS at the trust this was a huge piece of work involving clinicians, radiologists, directors and the lead cancer nurse for the trust. For the first six months of this project I was working single-handedly to run the telephone clinic five days a week, on top of my clinical and managerial duties, before eventually training one of my gynaecology CNS’s to provide me with some cross cover. In the first eight weeks of the telephone triage clinic being up and running I spoke with over 280 patients, and identified 19 cancers, three of which were non-H&N cancers. More recently I presented a poster at the BAHNO detailing the success of the nurse-led triage. I am extremely proud of this work, and particularly of how it can improve patient experience of being referred on a suspected cancer pathway. Being so involved at the front end of the pathway has also helped me to identify which patients are highly suspicious of having cancer, and has meant that I have been able to intervene and offer support at an earlier point.

As the CNS service at ESTH has grown over the last three years, I have been able to successfully prove the need for and recruit a second H&N CNS. I have worked hard to raise the profile of Head and Neck Cancer within the trusts that I have worked for, and I am enthusiastic and passionate about working with this amazing cohort of patients. I am so excited to be a part of BAHNON, working to further improve care for those people with Head and Neck Cancers.

Macmillan Clinical Nurse Specialist in Head and Neck

Base: Liverpool Head and Neck Centre, LUHFT, Lower Lane, Liverpool L9 7AL

Email: sally.lane@liverpoolft.nhs.uk

I began my head and neck journey in 1991, after completing the ENB AI5 Maxillofacial Nursing Course. Working as a Ward Sister in the Largest Head and Neck Centre in Europe. Working alongside the Senior Consultants we were able to develop National Standards and Care Pathways for Head and Neck Cancer Patients. This has gone on to establish an National and international reputation and I have helped host many visitors from overseas.