This interview was conducted by Maddie Baker, a postgraduate student at City University studying MA International Journalism. Rachel Baker became the first Macmillan funded Clinical Nurse Specialist (CNS) in Gynaecological cancer at St Bartholomew’s Hospital. Rachel’s career focused on women’s health, working at the Elizabeth Garrett Anderson Hospital for Women and as a research assistant at The Wolfson Institute of Preventative Medicine. For the last decade, Rachel worked as the Gynae cancer CNS at Kingston Hospital.
How would you describe your role as a Gynaecological cancer CNS?
The role of the Gynaecological cancer CNS was influenced by the already established role of the Breast Care CNS for women with breast cancer. As a Gynae CNS, my role over the past thirty years has been to support all women with a diagnosis of a gynaecological cancer. This comprises cervical, ovarian, endometrial, vaginal and vulval cancer.
I support women from the point of their diagnosis and throughout treatment and care, including liaising with their GP, community, and palliative care teams. Women who, through the national screening programme, are diagnosed with pre-malignant changes to the cervix are managed in the Colposcopy Unit. I therefore support women with Cervical cancer who are diagnosed through this service.
What inspired you to go into this area?
Working with women who were having surgery for Gynaecological cancer highlighted the enormous psychological impact of these procedures for women. I understood the need for specialist support for women and their families at this time. Research undertaken by the department underpinned the request for Macmillan Cancer Relief to fund a Gynae cancer CNS post. This was to be a specialist nurse to work as a member of the multi-disciplinary team caring for this group of patients.
What has been your experience of the successful HPV vaccine rollout in England?
As I see it, the approach to preventing cervical cancer involves the national screening programme and HPV vaccination. They are two separate things. The national screening programme has reduced the incidence of cervical cancer by over a third since its introduction in 1988. While the vaccine is a much more recent development, which aims to prevent the HPV infections that give rise to pre-malignant changes in the cervix.
Vaccination works by vaccinating girls (and boys) before the age at which you would expect first exposure to HPV. Early research into the effects of HPV vaccination from the first cohort of girls who have been vaccinated indicated that this can prevent over 98% of infections.
At the present time we are still waiting for the vaccinated cohort to reach a stage where this will impact on numbers of women being diagnosed with cervical cancer. There has actually been an increase in the number of young women diagnosed with cervical cancer since the 1990s. This is likely to be a result of a younger age at first exposure to HPV and its increased prevalence. Cervical cancer is likely to decrease in future decades, according to projections accounting for the expected impact of HPV vaccination.
Who are some of the people you have worked with who inspired you during your career?
A social worker, Hilary Everett who worked as part of the multi-disciplinary team at Barts. She was a key member of the research team investigating the psychological, psychosocial, and psychosexual impact of surgery on women.
Also, Professor John Shepherd, the Consultant Gynaecological Surgeon and Oncologist who led the Barts team. Professor Shepherd was passionate about ensuring his patients received appropriate psychological input. His support and understanding of the CNS role played an important role in its acceptance as an integral part of nationally agreed standards of care.
What are your thoughts about the nursing profession at present?
There is a chronic shortage of nurses at the present time. There has also been a change in nursing training from apprenticeships into universities. Although, there is also Associate nurse training, which integrates working on the wards and academic study.
Nursing should be more formally recognised as the profession it is. This will include meeting training fees and appropriate remuneration for the work that nurses do every day. The pandemic has showcased the essential work of nurses. Government policy should address the current workforce issues. We need to inspire the next generation of young people as to why they should choose nursing as a career option.
Would you be able to speak about some of the patients you worked with and whose stories stand out to you?
At Barts, the unit would see a significant percentage of women diagnosed with vulval cancer. Often these were older women, who presented with advanced disease. The surgery undertaken at the beginning of the 1990s was still radical in nature.
These women stay in my mind as they often presented late due to embarrassment or fear, and the nature of the treatment was extremely arduous. The need for support, information and advocacy for the patient became very clear to me.
Over the years, medical advances have involved more conservative treatments for younger women in order to preserve fertility. Younger women with cervical cancer will now be assessed for the possibility of Trachelectomy so they may be able to have children in the future.
What would you like to see going forward for the treatment of Gynaecological cancers?
In the last 30 years, the management of gynaecological cancers has become increasingly individualised, seeking to achieve optimal treatment outcomes with the minimum of physical and psychological morbidities. This focus on the individual promotes quality of life and going forward leads to a more positive outcome for women living with cancer.
For those working in this field, this is a welcome advance and will continue to be both an evolving and challenging goal.
Education is a key factor. As health professionals you want to promote screening and vaccination, so women and girls understand the importance of preventing cancer. Cervical cancers are 98% preventable, so that’s about good education. New cervical screening self-sampling trials -such as the YouScreen trial aim to make cervical screening easier. The intention is to encourage people who for various reasons may have slipped through the screening net. We need to work together creatively to ensure screening opportunities and information about signs and symptoms of all the gynaecological cancers are available and target those women who are difficult to reach. This promotes prevention and early diagnosis. There’s a lot of work to do in that.
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The views expressed are those of the author. Posting of the blog does not signify that the Cancer Prevention Group endorse those views or opinions.