Patient care

We take a multidisciplinary team approach to caring for our patients. All the staff involved are specialists in their field, many with an international reputation for their work.

Staff work together to ensure that there is a consistent and co-ordinated approach to treatment and care, ensuring that the best possible outcome is achieved for each child or young person.

Our wide range of expertise and specialist support includes:

Consultants

The cancer specialists working with families are recognised as leading clinicians, both nationally and internationally, for diagnosing and treating cancer in children and young people. They are supported by a team of qualified doctors in specialist training.

Specialist nurses

Our specially trained cancer nurses are experienced in caring for children and young people with cancer. Many hold nursing degrees, postgraduate qualifications and have advanced nursing skills. As well as being expert clinicians, they are committed to delivering compassionate care and maintaining an optimistic, friendly atmosphere.

Clinical nurse specialists

These nurses have specialist knowledge and skills in a particular cancer type, for example brain tumours, or a specific area of care, such as symptom management. They play a pivotal role in ensuring a patient’s treatment is seamless from the beginning.

Dietitians

They provide advice and education regarding a patient's diet and nutritional needs.

Occupational therapists

Occupational Therapists see and treat children and young people with functional difficulties arising from their diagnosis or treatment.

Physiotherapists

Patients are provided with expert input to improve movement and activity through exercise and practice with the help of a physiotherapist. This helps each patient reach their maximum potential. 

Symptom management and palliative care

The Outreach, Symptom and Palliative Care Service provides support, advice and symptom management advice to children and young people, and their parents/carers.

Play specialists

They provide emotional and developmental support to children, and create a friendly environment and sense of normality through play.

Youth support coordinator

The Teenage Cancer Trust Youth Support Coordinator provides opportunities for teenage and young adult patients to meet up with other young people by taking part in social events and activities both in and out of the hospital.

Psychosocial support team

The psychosocial support team complements the clinical team, offering support to address the needs of children, young people and their families as they deal with a cancer diagnosis. The team consists of CLIC Sargent social workers, consultant clinical psychologists, teachers and chaplains.

The physiotherapy service for children and young people is covered by designated physiotherapists:

  • Children: Michelle Payne (Ext 1082), Monday to Wednesday 9:30 to 14:30 and Thursday 9:30 to 13:00
  • Teenagers and young adults: Carla Reid (Ext 1644), Tuesday 8:30 to 14:45, Wednesday 8:30 to 14:45 and Friday 9:30 to 17:00.

The physiotherapy department will cover urgent referrals (tel 020 8661 3098) between 8:30 and 17:00 Monday to Friday (excluding bank holidays). Outside these hours, a 24-hour on-call service is available for emergency (i.e. chest) physiotherapy. This can be accessed via the switchboard.

All patients referred to the physiotherapy service will be prioritised according to clinical need, as determined by the physiotherapist.

Referral guidelines

Physiotherapy interventions can help in the following areas:

Respiratory:

  • Techniques to aid removal of retained secretions
  • Breathlessness management
  • Compromised respiratory function

Mobility

  • Assessment for walking aid
  • Balance and coordination problems
  • Peripheral neuropathy
  • General weakness

Neurological impairment

  • Increased or decreased muscle tone
  • Altered walking pattern
  • Spinal cord compression once medical management / treatment has been confirmed
  • Coordination and balance problems

Pain management

  • Assessment for TENS
  • Provision of soft collars

Fatigue

  • Decreased exercise tolerance and generalised weakness following chemotherapy and/or radiotherapy

Lifestyle / general advice

  • Exercise and healthy lifestyle advice 
  • Returning to activities following treatment

Follow-up

Please feel free to discuss referrals with the physiotherapy team.

Patients will be seen by the physiotherapists at The Royal Marsden during active treatment for their cancer. The need for ongoing physiotherapy will be determined by the physiotherapist. This may include:

  • Outpatient physiotherapy at The Royal Marsden
  • Referral to a local community team
  • Referral to a local physiotherapy outpatient service.

Please note: there may be times when a medical referral will be required for community and local physiotherapy input.

The occupational therapist sees and treats children and young people with functional difficulties arising from their diagnosis or treatment. They will look at any physical, sensory, cognitive, perceptual, social, developmental and psychological needs that may affect the ability to carry out activities of daily living (ADLs), with the aim of promoting or facilitating independence in all aspects of everyday life.

Referral guidelines

Occupational therapy interventions can help in the following areas:

  • Functional independence
  • Functional assessments and interventions including self-care, play, leisure, work
  • Upper limb assessments and intervention including handwriting and fine and gross motor problems
  • Assessment for ADL equipment, such as shower chairs
  • Assessment for wheelchair or buggy provision
  • Management of symptoms affecting independence, i.e. fatigue, anxiety or breathlessness
  • Liaising with teachers, offering advice to assist a return to school

Physical and sensory assessments

  • Neurological assessments and interventions, including splinting
  • Developmental assessment and education
  • Implementation and review of therapy programmes
  • Cognitive, perceptual and psychological intervention
  • Relaxation therapy and anxiety management
  • Informal cognitive and perceptual assessments and interventions
  • Discharge home from hospital
  • Planning discharge home from hospital, including equipment provision, onward referrals and contact with community teams

Specific interventions

  • Management of late effects, including chronic pain, ongoing fatigue and onward referrals to appropriate services
  • Functional reports to assist applications for re-housing
  • Functional reports to assist applications for charitable funding for items of equipment such as specialist buggies or wheelchairs.

Children and young people can be referred to Occupational Therapy Monday to Friday 08:00 to 16:30 (excluding public holidays) by calling 020 8661 3090. All referrals will be prioritised according to clinical need, as determined by the occupational therapist.

The occupational therapist will determine the course of intervention required and may, for example, refer onto local community services if a child is no longer receiving active treatment. Following occupational therapy intervention and treatment at The Royal Marsden, children and young people can be referred onto local community services for ongoing input, follow-up or review.

The paediatric and young people's speech and language therapy service provides assessment and intervention to support people with communication, swallowing or feeding problems as a result of their cancer diagnosis and treatment. This may include:

  • Assessment of swallowing/feeding skills
  • Assessment of speech, language and voice
  • Joint working with other professionals, such as allied health professionals, nurses and school staff
  • Liaison with other agencies
  • Advice to patients, carers and staff regarding safe swallowing
  • Advice to patients, carers and staff for optimising and supporting communication
  • Therapy programmes for those with swallowing or communication difficulties
  • Referrals to other specialist services, e.g. neuro rehabilitation
  • Ongoing review of communication or swallowing.
  • A service is provided to both inpatients and outpatients up to the age of 24 years. Referrals are accepted from staff and patients/carers, and can be made by calling 020 8661 3038.

The dietetic team aims to support patients who, due to the side effects of the diagnosis or treatment of their cancer, are at risk of malnutrition. Many of the methods used to treat cancer can have both short- and long-term side effects such as anorexia, fatigue, taste changes, xerostomia, mucositis, nausea, vomiting, diarrhoea, increased appetite and alerted blood sugar levels which in turn can lead to a change in nutritional status.

It is particularly important for children and young people to maintain their nutritional status during and beyond treatment to ensure that their growth and development are maintained. In addition to this, patients who are well nourished tend to spend less time in hospital, have an improved immune function and tend to receive a greater total amount of treatment.

Eating and drinking play a huge role in an individual’s health and wellbeing. It is the role of the dietetic team to ensure that as far as possible this vital part of everyday life is maintained and adapted to suit the individual.

Referral criteria for the dietetic service:

  • Any child with a greater than 10% weight loss
  • Any child who has fallen more than one centile line
  • Any child who is likely to be NBM for more than five days
  • Any child with bowel obstruction
  • All children having a stem cell transplant or high dose treatment
  • All children unable to eat due to uncontrolled nausea, diarrhoea, mucositis or taste changes
  • All children about to start Headstart, PACKER or Milan protocols
  • Children with excessive weight gain on steroids or secondary to endocrine changes, e.g craniopharyngioma.

The dietetic service provides support to both inpatients and outpatients and is able to provide advice on the following:

  • Food fortification and suitable food choices to aid weight gain
  • Dietary changes with taste changes
  • Healthy eating for normal growth
  • Food safety during neutropenia
  • Diet for steroid induced diabetes
  • Soft / liquid diet for mucositis or swallowing difficulties
  • Suitable food choices with nausea or diarrhoea
  • Safe use of oral nutritional supplements
  • Alternative and complementary diet advice
  • Anthropometric monitoring
  • Dietary changes with GvHD
  • Calculation of estimated nutritional requirements to ensure individualised feeding regimens provided
  • Formulation of individualised feeding regimens, taking into account both nutritional requirements and family routines
  • Teaching for parents and young people on the use of home enteral feeding equipment
  • Enteral tube care, support with checking tube positions, monitoring stoma sites and tube maintenance
  • Provision of feeding equipment for home.

The children's psychological care team is a multi-professional team of clinical psychologists and a child psychiatrist. It works very closely with the CLIC Sargent Social Work Team, play specialists, teachers and nursing and medical staff colleagues.

It is a very stressful time for a family when a child or young person is diagnosed with cancer, and many family members ask for extra support throughout their child’s treatment. The team offers many support groups which are run jointly with the CLIC Sargent team.

Clinical psychologists

Clinical psychologists specialise in child and adolescent development, assessment and treatment and will work with any member of the family to offer psychological therapy, support and advice. They are available to talk about how having a diagnosis of cancer affects everyone in the family and how it may change people's behaviour and feelings.

They can offer help with problems such as feeding, sleeping, toileting, tantrums, difficult or aggressive behaviour, changes in mood or anger issues. They can also offer advice about relationship problems and other complex issues.

A private space is available for parents or children to talk through what has happened to their family and to discuss with a clinical psychologist how best to help their child.

Child psychiatrist

The child psychiatrist works closely with other members of the team, particularly when there are more complex difficulties affecting mood or general wellbeing.

The psychiatrist will offer advice and support to all members of the family as appropriate. They also offer advice about any problems to do with school or attendance, memory, attention and concentration, and will advise about the need for psychometric assessments and statementing for special education needs.

How to see Children's Psychological Care Services

A referral can be made through your doctor or nurse or the CLIC Sargent team, or any member of the family can contact us for an appointment.

Sutton – Children's Psychological Care Services: 020 8661 3676

Teenagers and young adults have specific needs and can feel quite isolated when they are going through treatment. The CLIC Sargent Social Work Team can offer social, emotional and practical support to help minimise the impact of the illness and treatment. It works only with children, young people and adults under the age of 25.

As well as providing individual support to patients and their families the team runs a variety of group events for patients and family members.

If you are under 25 years old and need hospital treatment during an important time in your education, for example when you are studying for exams, you can contact the CLIC Sargent Social Work Team. Together with the hospital school staff they can provide advice and information as well as liaise with schools or colleges on your behalf. Any pupil or student on treatment is entitled to ‘special consideration’. For those who are too unwell to sit an examination, it may be possible to set a grade based on other evidence such as mock exam results.

How do I get to see a CLIC Sargent Social Worker?

You can contact the department yourself or through any member of staff at The Royal Marsden.

Sutton – CLIC Sargent: 020 8661 3880

Long-term follow-up (LTFU) is an essential part of care following treatment for cancer. Some procedures that children and teenagers may have received during their treatment can cause problems that only become evident years later. Regular clinic visits are important in order to detect any problems early on.

Following treatment, young patients will continue to see their oncology consultant regularly in clinic for the next five years (two years following a bone marrow transplant). At the end of this time care will be transferred to an LTFU team.

Late effects

Each child and young adult will have different problems and needs, and not all potential late effects occur. During your first visit to the clinic one of the LTFU team will go through each treatment and possible late effects with you. There is a checklist of possible late effects according to the treatment given which acts as reminder of what to look for. Once children reach the age of 18 years care is normally transferred to a consultant endocrinologist at St George’s Hospital in London.

The Outreach, Symptom and Palliative Care Service provides support, advice and symptom management advice to children and young people (and their parents / carers) who are aged between 1 and 19 years, have cancer and have been referred to the Children and Young People's Unit at The Royal Marsden.

We work closely with other teams at The Royal Marsden, and in partnership with children and young people, their families and local services close to where they live. This allows us to optimise symptom management and means that children and young people can be cared for in a place of their choosing. This service continues throughout the child or young person’s illness and into follow-up and/or palliative care and bereavement.

The team consists of four Children and Young People's Oncology Outreach and Symptom Care Nurse Specialists (CYPOONS) and one Paediatric Consultant in Palliative Medicine.

Find out more on the team's department page.