Leukaemia UK Mind & Body project

The Leukaemia UK Mind & Body Team project developed a specialist approach to people living with blood cancer and related difficulties.

Advances achieved in medical treatments for blood cancers and diseases needed to be matched by much greater emotional and wellbeing care for the person affected by blood cancer and their loved ones. Funded by the charity Leukaemia UK at King’s College Hospital NHS Foundation Trust, the team aimed to improve mind and body care for patients and families.

The psychological impact of treatments for leukaemia, lymphoma, myeloma, and other blood diseases are quite different to those of other cancers. There is no tumour to ‘remove’ from the body, and treatments involve the need for isolation from infection, making visiting and social contact very difficult for many weeks. Emotional support during and after this period should therefore be an essential part of treatment.

It is for this reason that the project was launched – where people affected by blood cancer routinely received psychological support where needed, expanding current service provision.

The team consisted of a dedicated Psychiatrist, Clinical Psychologist, and Social Worker, who provided specific support for patients with haemato-oncological conditions located at King’s College Hospital NHS Foundation Trust, for an initial period of two years. 

The project resulted in: 

• Successful implementation of psychosocial heath screening for every myeloma patient regardless of treatment pathway and intention. 
• Holistic conversations with myeloma patients increasing access to psychosocial, AHP and other specialist services 
• ‘One stop’ referral form for screening triggered referrals to Mind and Body professionals 
• Mind and Body clinical conversation training for clinicians at all levels  
• Quality improvement programme underpinning eIMPARTS screening leading to improvements in screening implementation 
• Ongoing clinical audit of eIMPARTS pseudonymised data to enhance understanding of screening outputs. This is instrumental to understand screening equity and diversity of those completing measures as well as the characteristics of patient reported concerns informing further service investment 
• Increased identification of social and psychological needs for haemato-oncology patients, resulting in increased access to psychological therapies and support for their practical and social needs. 
• Completion of multi-phase feasibility project evidencing Mind and Body approach in Haemato-oncology.

The success of this project resulted in substantive funding for a senior social worker and psychological therapist/psychologist to work in Haemato-oncology and Haemoglobinopathies.  A dedicated consultant psychiatrist was also recruited to work across the King’s Cancer Services, including care for people with haemato-oncological diagnoses. 

Here is an overview of the project approach 

‘Business as usual’ pathway 

Our Psychological therapy team offered mental health assessment and support for people with Haemato-oncological disease and their families. For the duration of the Mind and Body Programme, this service has continued to receive non-IMPARTS psychological referrals and has more recently supported the transition period at the end of the funded programme, now incorporating IMPARTS related referrals into this service. 

At just beyond the halfway point in the reporting year for the Haemato-oncology Psychological therapy service, referrals have increased. With the current trajectory, the total number will be over 480 by year end; a significant increase from 409 the previous year. 

Screening & Interventions 

An initial feasibility study was undertaken to assess the suitability of the eIMPARTS tool for Haemato-oncology patients and the developed pathway.  Interim analysis performed in January 2020 included appraisal of screening processes and quantified patient needs and resulting interventions resulting in the implementation of eIMPARTS across myeloma clinics.   

More than 400 patients completed patient reported outcome measures looking at psychological distress, quality of life, social needs between October 2020 and October 2021.  As a result, longitudinal data for many of these patients is also available to track progress. More than 10% of patients had clinically significant symptoms of low mood, and/or anxiety.  47% of patients were identified as having unmet practical and social needs, 25% of which required social work support.  Many patients received interventions for poor sleep, pain, weight loss and eating and sexual dysfunction difficulties identified by the pathway.  

Mind and Body Multidisciplinary team (MDT) meetings 

Weekly Mind and Body MDT meeting to discuss new cases, existing complex cases, and those at risk.  The MDT included the Body Psychiatrist, Clinical Psychologist, Social worker, Haematology Psychotherapists and Physiotherapist as well as representation from Haemato-oncology medical and nursing staff.   

The MDT also offered a forum to discuss cases arising through eIMPARTS using the Mind and Body multi-professional referral form 

Mind and Body Clinic 

A routine Mind and Body clinic was established with access to psychological therapy for patients and family members, psychiatry and social work input.   

Prehabilitation 

The prehabilitation service provides dietetic and physiotherapy screening and intervention to patients who have been consented for a bone marrow transplant. The service seeks to optimise patients, thereby addressing malnutrition and deconditioning needs often experienced through chemotherapy. The rehabilitation service provides dietetic and physiotherapy input to those patients who are currently having systemic treatment for their haemato-oncological diagnosis, aiming to minimising deterioration in nutritional and functional status.  

The top three reasons for referral for physiotherapy when qualitatively analysed were fatigue, deconditioning and reduced physical activity. The average time for prehabilitation for physiotherapy was 56.3days (range from 24 to 90+ days). 

For the dietetic rehabilitation service, 92% of referrals were for patients who either had evidence of malnutrition or were at risk of malnutrition, characterised as 5-10% weight loss within 3-6 months, or symptoms significantly affecting their ability to eat and drink. 79% of dietetic prehabilitation referrals required specialist nutrition support in order to optimise their nutritional status.   

The dietetic service provided to the King’s haemato-oncological patient cohort demonstrates the high rate of malnutrition amongst this patient cohort, and the need for specialist dietetic support both in the prehabilitation and rehabilitation stages of the pathway. 

Education & Staff Support 

Staff supervision 

A monthly supervision group facilitated by psychology was started for Haemato-oncology clinical nurse specialists.  Additional support was also offered via staff meetings and discussions with the nurse in charge of outpatients.  

Micro-teaching 

Micro-teaching consists of bite-sized sessions provided to staff opportunistically and frequently, delivering the same topics repeatedly until the majority of staff have been trained.   Topics included  Responding to distress and dealing with confrontation 

Mind and Body Clinician Training 

Sessions were conducted with teams outlining the screening workflow, responsibility to identify and respond to completed screens and the IMPARTS specific multi-professional referral process. The team are encouraged to use both completion or non-completion of screens as an opportunity to have a holistic conversation with the patient. Training also supported clinical staff to engage with the e-IMPARTS WHOQOL screening to identify and respond to social need and refer appropriately to the social worker as required.