Macmillan clinical nurse specialist Michael Evans discusses a case with Sandra Carty, ward sister
Royal Brompton Hospital, in partnership with the National Heart & Lung Institute, runs the busiest clinical service in the UK for the investigation and management of occupational and other environmental lung diseases. Patients are referred from all parts of the UK for NHS treatment and care. The department has pioneered the investigation of occupational asthma for the past 20 years and runs one of the few laboratories in Europe that specialises in occupational and environmental allergen testing.
Occupational asthma refers to asthma that is caused or worsened while working in particular jobs where allergens are present, most commonly flour, eggs, mammals, latex and seafood but can also be caused by agents that a worker might come into contact with in industries such as spray painting, hairdressing, metalwork, construction, dentistry etc.
This form of asthma rarely responds to standard asthma treatment and usually results in major disruption to a patient’s employment.
Professor of occupational and environmental respiratory disease, Paul Cullinan, and his team, are currently involved in extensive research concerning egg allergy, laboratory animal allergy and baker’s asthma.
They also run regular postgraduate short courses and workshops.
Lung cancer care
The Trust provides specialised care for patients with suspected or diagnosed cancer affecting the chest (thoracic oncology). Patients can expect a whole care package from our multidisciplinary team who work with them and their families to help them choose the best treatment option and assess any needs they might have. A comprehensive patient service
With a multidisciplinary (MDT) team that includes clinical nurse specialists, thoracic surgeons, respiratory physicians, oncologists, histopathologists, radiologists, palliative care specialists and rehab and therapies professionals, patients benefit from the support of having often national and international experts in one place.
Dr Alison Leary, Macmillan lead cancer nurse at the Trust, says: “Patients are referred to the Trust for different reasons and at different points in their cancer journey. This may be for a diagnostic procedure or curative lung cancer surgery, both of which are highly specialised. The surgical team also performs palliative surgery to improve a patient’s quality of life, which includes helping to alleviate symptoms such as shortness of breath in people living with more advanced cancers. Other very specialist areas include radio frequency ablation, laser surgery, sternal replacement or reconstruction and chest wall reconstruction.”
Most of the Trust’s work is tertiary, therefore the majority of patients are referred from other centres around the country. Colleagues work in close partnership with neighbours at the Royal Marsden, Chelsea & Westminster and Mount Vernon hospitals, meaning patients can expect a seamless and speedy transfer for further treatment where needed – or choose to be referred to a hospital closer to home if preferred. Specialised cases are regularly referred to the team for opinion and treatment, including the diagnosis of unusual chest problems related to conditions such as leukaemia and bone marrow transplantation. A variety of cases are discussed at MDT meetings, which are often attended by specialists from other trusts who are seeking our opinion on their case. Key facts and figures
- We treat around 500 confirmed cancers each year but also provide a diagnostic service for people with suspected cancer that is much higher – these patients often need the emotional support or care co-ordination offered by our multidisciplinary team.
- The sarcoma team at Royal Brompton Hospital is the designated exclusive provider of thoracic sarcoma surgical services for the London and South East England, which serves a population of 18.5 million and is the largest sarcoma network in the UK. This came about as the result of the "Improving Outcomes for Patients with Sarcoma" NICE guidance, focusing on centralisation of treatment for these rare cancers to centres with accumulated expertise and a track record of excellent results.
- Patients travel from all over the country to be treated by our cancer and supportive care team.
Video assisted (VATS) lung resection
In an exciting development for the treatment of lung cancer, video assisted (VATS) lung resection techniques have now been established within the surgical service.
Most resections for lung cancer – removing lung tumours – are performed through an open incision for access into the chest cavity. But for some patients, VATS lung resection offers a suitable alternative that is less invasive as the operation is performed using a series of smaller incisions with video assistance (also known as keyhole surgery).
Evidence to date shows VATS lung resection is already achieving impressive results, with patients who undergo the surgery experiencing less pain and a shorter hospital stay after their operation.