Rehabilitation

This page identifies some of the Rehabilitation services available in the United Kingdom for patients suffering from radiation induced - Late Effects in Normal Tissue [LENT] injuries. These are available for Breast, Pelvic, Gastrointestinal, Head and Neck patients.

Complex Cancer Late Effects Service

https://www.crpsandcancerlateeffects-bath.org.uk/about-the-service/

The Complex Cancer Late Effects Rehabilitation Service, at Bath in Somerset, provides treatment for two different groups of patients:

  1. Breast Radiation Injury Rehabilitation (BRIRS)

  2. Complex Cancer Late Effects Rehabilitation (CCLERS).

Both of these services use the same pathway of assessment clinic, rehabilitation programme and follow up. Both services are funded by NHS England.

The Breast Radiation Injury Rehabilitation Service was set up in 2012 to help patients who had sustained brachial plexus injury. This has been regarded as a rare consequence of radiotherapy treatment for breast cancer.

It was historically more common and is usually associated with now outdated radiotherapy practices. Patients may present with a complex range of symptoms. These can include: severe and constant pain in the affected arm, limited function of arm and hand, lymphoedema and skin changes of the arm on the affected side.

Symptoms of brachial plexus injury may arise several years after treatment. Building on the success of BRIRS, Royal University Hospitals in Bath has now developed the Complex Cancer Late Effects Rehabilitation Service.

The Complex Cancer Late Effects Rehabilitation Service (CCLERS) is a specialist rehabilitation service for people experiencing unresolved persistent pain and reduced physical function due to the consequences of treatment for cancer in any tumour site.

The criteria for each service is shown on our ‘referral and pathway process’ page:
https://www.crpsandcancerlateeffects-bath.org.uk/referral-and-pathway-process/


Other Links from Bath.....

Complex Cancer Late Effects Service Leaflet
CRPS Patient Experience August 2017

The full 2nd edition of the UK CRPS guidelines is available to download here: Complex regional pain syndrome in adults July 2018

CRPS/CCLERS Service Lead
RNHRD & Brownsword Therapies Centre
Royal United Hospital
Combe Park
Bath BA1 3NG

Email: ruh-tr.RNHRDCRPSteam@nhs.net
Telephone: 01225 821127

Breast Radiotherapy Injury Rehabilitation Service

The Royal National Hospital for Rheumatic Diseases has been at the forefront of specialist treatment and rehabilitation for complex conditions for over 250 years. It continues to advance this reputation for excellence and innovation.

The Breast Radiotherapy Injury Rehabilitation Service was designed for a discrete cohort of women who have severe, chronic and complex conditions arising from radiation-induced injuries.

These women received high doses of radiotherapy in the 1970s and 1980s – the favoured treatment in some centres at the time – for breast cancer. The BRIRS provides a specialist, multi-disciplinary rehabilitation service.

The Royal National Hospital for Rheumatic Diseases NHS Trust has provided evidence based, national and regional services for adults living with and beyond cancer. Referrals can be made directly by potential patients, by a member of their cancer team or by their GP.

BRIRS short film: https://vimeo.com/90741807

RAGE and the Breast Radiation Injury Rehabilitation Service (BRIRS) Clinics

In 2008/2009 a Radiotherapy Late Effects Pilot project was conducted by Macmillan Cancer Care UK in partnership with the NHS National Cancer Action Team and Radiotherapy Action Group Exposure (RAGE).

The aim of this pilot was:

  • to explore how best to deliver effective integrated care for people living with the long-term effects of radiotherapy treatment for breast cancer;

  • to test the efficacy of telephone triage;

  • to test the short-term benefits of a single multi-disciplinary team (MDT) assessment/care planning appointment.

The pilot demonstrated:

  • telephone triage could effectively identify the needs of the patient;

  • assessment and care planning can take place effectively at regional centres;

  • direct referrals from specialist clinics are the most effective way to initiate local services and support;

  • those experiencing extreme pain reduced by 14% post-intervention.

In 2011 a two day residential programme was piloted at The Royal National Hospital for Rheumatic Diseases (RNHRD) in Bath, again with RAGE members taking part:

  • Qualitative and quantitative data was collected from 29 patients at the outset.

  • After completion of the two-day residential programme follow-up data was collected.

  • Questionnaires covered patients’ physical and mental wellbeing, use of healthcare resources and personal evaluation of the service they experienced.

Patients’ feedback from these clinics in general was overwhelmingly positive. Patients appreciated a tailored service that met their specific healthcare needs and the ability to talk to clinicians who understood their problems.

The two day service was reported to have had an immediate and profound impact for many of the women treated.

In 2013, as a result of these two pilot studies, funding was agreed by the NHS Commissioning Board (now NHS England) to provide for three Breast Radiation Injury Rehabilitation Service (BRIRS) Clinics to be set up at:

  • Royal National Hospital for Rheumatic Diseases, Bath

  • Barts Health NHS Trust, London

  • Christie Hospital NHS Foundation Trust, Manchester

Unfortunately the NHS funding for this project did not survive long and the two satellite Clinics at Bart’s and Christie Hospitals were the almost immediate casualties.

The Breast Radiation Injury Rehabilitation Service Clinic at Bath has continued and has now effectively been expanded with a second Clinic to meet the needs of all cancer patients treated with radiotherapy.

Specifically the Breast Radiotherapy Injury Rehabilitation Service continues to optimise clinical outcomes and deliver appropriate care for this breast population across a wide geographical spread; monitor the long term surveillance following definitive treatment; bring together a highly specialised multi-disciplinary team who have a clear understanding of the healthcare needs associated with this rare condition; expand clinical expertise that will generate new knowledge of the course, cause and treatment of this condition and the symptoms that arise from it in order to inform future cancer care.

The BRIRS referral criteria is: - known brachial plexus injury following radiotherapy treatment for breast cancer.

The "new" Complex Cancer Late Effects Rehabilitation Service (CCLERS) Clinic considers referrals for adults aged 18 years and over:

  • With unresolved persistent pain and reduced physical function due to the consequences of treatment for cancer in any tumour site.

  • Already seen by local pain and rehabilitation services (i.e. primary/ secondary physiotherapy services) without improvement and/or deterioration in symptoms

  • Considered complex/ highly complex by local or regional services due to physical and/or psychological needs

  • Completed cancer treatment more than 12 months ago (excluding hormone therapy)

All BRIRS/CCLERS services are national specialist commissioned services by NHS England, so prior funding approval is not required for patients living in England.

For people outside England, local area funding approval will need to be obtained before a referral is submitted. Private referrals are also accepted.

Referrals should be received in writing from a pain specialist.

GP referrals should be submitted through the Choose & Book system.

All written referrals should be sent to the address below:

BRIRS/CCLERS Service Lead
RNHRD & Brownsword Therapies Centre
Royal United Hospital
Combe Park
Bath
BA1 3NG

Email: ruh-tr.RNHRDCRPSteam@nhs.net
Telephone: 01225 82112