Bladder Cancer Care

Programme aims

We will ask visiting professionals to outline specific learning objectives and we will aim to tailor the fellowship to meet these, including observation and active participation in the multitude of nurse led services, clinics and procedures. 

Opportunities include: 

• Observation of urological surgical procedures including endoscopic, laparoscopic, robot-assisted and open cases
• General outpatient / One Stop Clinics 
• Specialist Bladder Cancer Clinic/Upper Tract Urothelial Carcinoma MDT and Clinic
• Nurse Led Flexible Cystoscopy Clinic 
• Nurse Led Intravesical Treatment Clinics 
• Patient Focus Groups and Educational Sessions 
• Radiation Therapy and Radiology Practice 
• Systemic Chemotherapy/immunotherapy 
• Functional Urology Including urodynamics, Botulinum toxin injection sessions and Incontinence Clinics (if required – will be made available) 
• Sexual health and post cystoprostatectomy/prostatectomy erectile dysfunction clinics 
• Proactive Care of Older People (POPS) 
• Stoma input with patients 
• Dimbleby service at Guy’s 
• Clinical Trial / Research Support Service

Learning objectives

Bladder Cancer (Anatomy/Physiology/Pathology)

• Develop an understanding of urethral, bladder, and renal anatomy required for specialist urological nursing practice 
• Understand basic physiology of bladder function and consequences of altered/dysfunctional bladder in males and females 
• Further ones understanding of bladder and upper tract urothelial cancer, understanding risk factors, prognostic factors and rationale of treatment 

Non-Muscle Invasive Bladder Cancer

• Develop an understanding or disease management, recurrence and progression including staging and classification systems 
• Understand the treatments recommendations of Ta, T1 tumours and CIS according to risk stratification 
• Comprehension of the surgical management strategies including radical cystectomy for NMIBC 

Muscle Invasive Bladder Cancer

• Understand radical surgical options available and reconstruction techniques (Radical cystectomy, ileal conduit, neobladder, mitrofanoff) 
• Develop an understanding of the complex management pathways of patients, pre, intra and postoperatively 
• Overview of Guy’s enhanced recovery program 
• Knowledge of the importance of POPS assessment 

Metastatic Bladder Cancer

• Diagnostic evaluation, disease management and psychological implications of metastatic disease diagnosis 
• Prognostic factors and treatment decisions and end of life planning 
• Role of immunotherapy 
• Adjuvant treatments available and when is it appropriate to stop treatment? 
• Recommendations for the use of biomarkers 

Upper Tract Urothelial Carcinoma

• Understand the relationship between upper tract urothelial carcinoma and bladder cancer 
• Develop an understanding of treatment modalities required to manage upper tract urothelial carcinoma 
• Understand follow-up regimens for the lower tract in patients with upper tract urothelial carcinoma and the role of the specialist nurse in managing these patients 

Intra-vesical Treatment Administration

• Understanding modes of intravesical therapies including the Di Stasi regimen 
• Understand the difference between passive and active (device assisted drug delivery) Mitomycin C 
• Understand options for BCG failure and indications for primary cystectomy
• Familiarise self with treatment recommendations for BCG failure and recurrences after BCG and follow-up 

Nurse Led Flexible Cystoscopy Surveillance

• Learning how to run a robust nurse-led Flexible cystoscopy service 
• Develop strategies to manage risk and uncertainty during cystoscopy 
• Recommendations for follow-up patients after TURBT 

Holistic Bladder Cancer Care

• Introduction to holistic needs assessment (HNA) and how it works 
• Overview understanding of care pathways individualised to patients needs 
• Observation of Dimbleby Centre and services

Who can apply

This programme is intended for nurses who have a special interest in bladder cancer or whom want to develop their skills further within bladder cancer nursing.

Programme duration

Four one-week fellowship positions are awarded each calendar year (approx. once every four months). For more information regarding the fellowship and to request an application form, please contact: Ms. Kathryn Chatterton Specialist Nurse in Bladder Cancer Guy’s & St. Thomas’ NHS Foundation Trust Kathryn.Chatterton@gstt.nhs.uk.

Bladder Cancer service

Guy’s Hospital has a well-developed clinical and academic interest in bladder cancer, with a high-volume tertiary referral practice in robotic cystectomy. The department pioneered the introduction of robotic cystectomy in the UK and in 2017 over 80 cystectomies were performed. The team also has well developed clinical expertise in bladder conservation with innovative programmes in photodynamic cystoscopy, en-bloc resection and sequential intravesical EMDA chemo-immunotherapy. Clinical research programmes exist in all areas of bladder cancer and our work has been published on cystectomy, PDD, novel methods of TURBT, intravesical therapy, and PET scanning. Specialist bladder services provided include a dedicated upper tract urothelial carcinoma service, management of radiation cystitis, salvage cystectomy, redo-ileal conduit reconstruction, and laser bladder tumour ablation. We have also contributed to trials of new systemic agents in advanced disease and in radiotherapy for bladder conservation.

Bladder Cancer Clinical Nurse Specialists at Guy’s Hospital

The Guy’s bladder cancer specialist nurse programme is supported by two clinical nurse specialists, Suzanne Amery and Kathryn Chatterton, who solely look after patients with bladder cancer. Sue Amery started working in the Urology Centre in 2008 and has developed a robust training schedule for intravesical therapies for the nurses and introduced Electromotive Device Assisted mitomycin (EMDA) to the trust. Both CNS’s have committed to a Bladder cancer support group for the trust. Kathryn has been working in the department since 2003, establishing the nurse-led cystoscopy service and enhanced recovery service for cystectomy patients at Guy’s. She also spent a year in Melbourne in 2009 where she established the first nurse-led flexible cystoscopy service in Australia.

Example Timetable

Fees

A course fee per week will be applied; this fee excludes accommodation and travelling expenses. To find out the fee amount please email vpp@gstt.nhs.uk.

Please note

Clinicians are able to offer bursaries or discounted placements on an individual basis. This is at the discretion of the Directorates of GSTT and does not affect the terms and conditions of the Visiting Professional Programme agreements.