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This offers information on the Kingston Hospital Paediatric Oncology Shared Care Unit (POSCU). POSCU is located in the Andrew Winrow Oncology Unit.
When a child or young person is diagnosed with cancer, it is a difficult time for parents, children and young people. Throughout their treatment you will meet healthcare specialists in several hospitals.
This information helps to explain their roles and offers guidance on the care, support and treatment that you and your child or young person will receive during the next few months.
About shared care
Care for children and young people with cancer is planned and co-ordinated by a paediatric cancer centre (called a Principle Treatment Centre or PTC). These centres include the Royal Marsden Hospital, Great Ormond Street Hospital and University College London Hospital.
At the PTC, your child or young person’s consultant oncologist will discuss the following:
- confirmation of diagnosis
- treatment plan
- future outcome
- possible side effects and complications of treatment
- possible national or international clinical trials (see Clinical trials below).
Some of your child or young person’s care will be undertaken at the PTC. Some care can be provided at Kingston Hospital’s POSCU. Other treatments may be provided at your home.
We are in regular contact with the different teams involved in your child or young person’s care. We believe this is vital in helping to make their journey as smooth as possible.
Clinical trials
Your child or young person’s oncology team will discuss national or international clinical trials that you may consider enrolling your child or young person onto. These trials are crucial for improvements in treatment and outcomes. They also help reduce side effects from the various treatments used for any cancer.
Whether you decide to take part in a trial or not , we will always respect your decision. Your decision will never affect how we treat your child or young person, or the clinical care they receive.
The role of Kingston Hospital’s POSCU
POSCU’s role is to deliver as much care as close to home as possible for children and young people with cancer. POSCU does this in collaboration with your Principle Treatment Centre (PTC).
At Kingston we follow your child or young person’s agreed treatment plan from their PTC, and deliver much of the supportive care that may be needed.
We may see your child or young person at the POSCU to administer chemotherapy, other medications, blood transfusions and medical reviews.
The POSCU team will always follow your child’s or young person’s PTC protocol. However, other decisions regarding supportive care, for example antibiotics or blood transfusions, will be made by a POSCU consultant.
There will be regular telephone discussions and email correspondence between POSCU and the relevant PTC to keep them updated. When your child or young person is discharged home, their PTC will be emailed a discharge letter, to ensure they are aware of all care given at Kingston Hospital.
If you have specific concerns or queries, please bring them to the attention of the specialist oncology nursing team, POSCU consultant, or the ward team. If you are still concerned, staff can arrange a meeting with either a POSCU consultant or the Paediatric matron, to discuss your concerns.
POSCU opening hours
- Our POSCU is open Monday to Friday, 8.30am to 5.30pm.
- Outside these hours we may ask you to visit Dolphin ward (the Kingston Hospital children’s daycare ward).
- If your child or young person needs to be admitted to the hospital, they will attend Sunshine ward (the Kingston Hospital children’s inpatient ward).
Supportive care available at POSCU
At Kingston Hospital POSCU, we offer care for a range of events and situations.
Use the drop-down menu below to find out more.
Febrile episodes
A febrile episode happens when your child develops a temperature of 38 degrees or more, often because of an infection.
This infection usually develops because their white blood cell levels drop due to the effects of chemotherapy treatment. (Chemotherapy puts them at higher risk of infection).
This is called febrile neutropenia.
If this happens, your child or young person will need a medical review. Usually we admit them to Kingston Hospital’s Sunshine ward so they can receive intravenous antibiotics to treat the infection.
During this time, they will stay in an isolation cubicle to prevent them catching another infection while they are being treated. The average length of stay in hospital is 2 to 4 days, depending on the individual child’s response to treatment and their test results.
Sometimes (depending on their stage of treatment), they may have a normal level of white blood cells but still develop a fever. This is called febrile non neutropenia.
If this happens, they may not need to be admitted to hospital. This decision will be discussed with you. It depends on the most likely cause of infection and their test results. Some children or young people may need to stay in hospital for treatment, while others may be given oral (by mouth) antibiotics and allowed home.
When it is safe to send your child or young person home, we may discharge them to receive intravenous (via a vein) antibiotics given at home. This is carried out by the Kingston Paediatric Outreach Nursing Team (PONT), the Hounslow and Richmond Children’s Community Nursing Team or another designated children’s community nursing team (CCN).
Whenever possible, we stop intravenous antibiotics around 48 hours after initial hospital admission and switch to giving oral antibiotics. This decision depends on our investigation results, your child or young person’s temperature, and how well they feel.
Administration of chemotherapy
At POSCU, our goal is to reduce disruption to your family life by providing care closer to home or even in your home.
We may ask your child or young person to visit the Kingston Hospital POSCU so we can administer certain types of chemotherapy drugs. We do this when requested by the PTC and in line with your child or young person’s cancer care plan. This helps reduce the number of visits that you need to make to the PTC.
These chemotherapy treatments are administered by our specialist children’s cancer nurses or paediatric specialist nurses. These nurses have been assessed as competent to perform this procedure and we reassess them regularly. They administer chemotherapy to your child or young person via a vein, using a special ‘central venous access device’.
Sometimes children’s community nurses can administer chemotherapy at home. If your child or young person needs other more complex chemotherapy treatments, the PTC will need to administer these.
Administration of blood products (blood transfusion and platelet transfusion)
A fall in blood counts often occurs after chemotherapy. This may cause your child or young person to become anaemic (low red blood cell levels). Or it could cause them to have a low platelet count known as thrombocytopenia (platelets are the cells which clot blood). This can increase their risk of bleeding or bruising.
If this happens, we can give them:
- a blood transfusion to increase their red blood cell level, or
- a platelet transfusion to increase their platelet count.
Both of these can be performed in the POSCU. They can also be performed on Dolphin ward (depending on the time of your visit).
Help with questions about treatment
If you have questions about your child or young person’s treatment, you can ring us on the direct telephone number for the POSCU. Monday to Friday, 8.30am to 4.30 pm.
If your concerns are more detailed or serious, we may ask you to come to the POSCU or Dolphin ward for a clinical review with a doctor.
If you have questions outside of our service hours, you can use the contact numbers which are listed on your ‘direct access’ letter from the POSCU. This will enable you to get in touch with relevant team members or access an immediate doctor’s review if you need one.
Who you will see at Kingston Hospital
There are different members of the multidisciplinary team (MDT).
All of these allied members of your child or young person’s MDT are invited to join a monthly MDT meeting. This MDT meets every month to discuss each child and young person and ensure that there are no new problems that need to be addressed. The MDT comprises consultants, CNS, oncology sisters and the community team.
Use the drop-down menu below for more information.
Specialist nursing staff
An oncology Clinical Nurse Specialist (CNS) and specialist oncology sisters will be the Kingston Hospital key workers for your child or young person.
They will be supported by teams of ward sisters and staff nurses on Sunshine and Dolphin wards.
If the specialist oncology nursing team is not available, the senior nurses on Sunshine and Dolphin wards will be able to help you with any concerns.
Medical staff
The POSCU paediatric consultants have overall responsibility for all children and young people with cancer at Kingston Hospital. They work closely with the oncology consultant at the relevant PTC.
A POSCU consultant and the specialist oncology nursing team do a ward round every weekday to assess your child or young person. They discuss investigation results, monitor progress and plan further clinical care.
This is usually a good opportunity for you to ask questions.
Our paediatric wards also operate a named consultant of the week system. These paediatricians help to manage oncology patients on Sunshine and Dolphin wards during the week and particularly at weekends. They will liaise with the POSCU consultants if there is any change in the condition of your child or young person.
These consultants are supported by junior paediatric doctors, although some will be senior trainees who are about to take up consultant posts. Working alongside nursing staff, they are present around the clock, to ensure your child or young person is cared for in a safe medical environment.
Allied health professionals
Other members of the multidisciplinary team (MDT) include community nurses, physiotherapists, dietitians, pharmacists, speech and language therapists and play specialists.
Children’s Community Nurses (CCNs) or Kingston’s Paediatric Outreach Nursing Team (PONT)
These nurses liaise closely with your POSCU team. They provide care and support for you and your child or young person at home. They take blood samples and administer intravenous antibiotics and certain types of chemotherapy.
CCNs and PONT members will visit you soon after discharge home from hospital to provide clinical care, support or advice.
Their contact numbers, and the name of your community nursing key worker, will be given to you at your first home visit.
Chaplaincy team
Kingston Hospital has a multi-denominational chaplaincy team. You can ask for their support via the specialist oncology nursing team or via any ward team member.
Play specialists
Kingston Hospital has a children’s play team who will be actively involved in your child’s care throughout their treatment. They will make each of your visits or overnight stays as stress free as possible for you and your family.
Momentum children’s charity
A family support worker, from local charity Momentum, is available in the POSCU Unit and on Sunshine ward most days, and you will be able to meet them.
Momentum provides support to all our families and to the Kingston Hospital Paediatric Department in general. It has helped us to improve our wards and outpatient environments over the years, and generously contributed to the decoration of our POSCU Unit and numerous areas of the Paediatric Department.
If your child needs admission to Kingston Hospital
If the admission is pre planned and is a day case, then your child or young person will be admitted to the POSCU or to a cubicle on Dolphin ward.
If your child or young person is admitted with a temperature, particularly if they are neutropenic, we aim to administer intravenous antibiotics as quickly as possible. Ideally we will do this within the first hour of your attendance.
Sunshine ward cubicles
If your child or young person is unwell, particularly if they have a febrile neutropenic episode, they will be admitted to an isolation cubicle on Sunshine ward for treatment. These cubicles have their own toilet facilities.
Admission to an isolation cubicle is necessary to prevent your child from acquiring an infection from another patient on the ward.
Because of the risk of contracting an infection, it is important that your child or young person stays in the room and does not go to the playroom or walk around the ward.
Our team of play specialists will offer your child or young person the opportunity to visit the playroom or teenagers’ room at a designated time, separate to other patients.
Space in the cubicles is limited, but a fold-up bed is available so you can stay with your child or young person overnight. Try to tidy away your belongings as much as possible so that we can clean the room every day. A senior nurse will monitor room cleanliness daily.
The highest standards of hand hygiene are essential on our wards. All the staff and all visitors must wash their hands to reduce the risk of bringing an infection into the POSCU from outside the ward or from home.
Parking
The ward nurses will explain catering arrangements and car parking fees.
If you are a Blue Badge holder, you can register your badge with Kingston Hospital to ensure free car parking. See Contacts below.
Important
We make every effort to prioritise your child or young person and treat them as quickly as possible.
Inevitably, there are times when our staff are busy with a child who needs urgent, lifesaving care. In these situations, we ask you to be patient.
Follow up after your child or young person has finished treatment
Your child or young person will have direct access to the Paediatric Unit for 1 year after their treatment. For those completing treatment after their 18th birthday, the period of direct access is reduced to 6 months.
Your child or young person’s planned follow up will be shared between the PTC and POSCU.
During follow up appointments your child or young person will be monitored for any signs of possible relapse.
Kingston Hospital’s lead POSCU consultant holds an oncology outpatient clinic every month. Appointments will be arranged with you by the POSCU MDT coordinator.
Contact the POSCU MDT coordinator if you wish to meet with the lead POSCU consultant at any time (see Contacts section).
The whole POSCU team meets for an MDT meeting every month to discuss each child and young person and ensure that there are no new problems that need to be addressed. This POSCU team comprises consultants, CNS, oncology sisters and the community team.
If you would like any aspect of your child or young person’s care to be discussed within this group, discuss this with your community nurses or with a member of the specialist oncology nursing team (see Contacts section).
Introducing other sources of support
We may introduce you to other sources of support for your child or young person, you and your family.
This may include a local hospice. The term ‘hospice’ is often thought to relate only to end of life care, but this is not always the case. Hospices can offer family support, symptom management for your child or young person and/or therapeutic activities and experiences such as swimming.
Transition to adult cancer services
As your young person matures into their mid or late teenage years, it will be necessary to start discussing transition of care to adult cancer services.
For most children, up to the age of 18, who need long term follow up, this usually switches to their PTC’s Late Effects Clinic at around 5 years from the end of treatment. The Late Effects Clinic monitors for long term side effects of previous treatment.
For those approaching their 18th birthday (but still within 5 years of finishing treatment) there will be a discussion about whether to switch their care solely to the PTC. If your young person is going on to start further education, a PTC which is local to their educational residence may be more appropriate.
For those approaching their 18th birthday who are still receiving active cancer treatment, their treatment and supportive care is likely to continue in the Kingston Hospital Paediatric Department for a while longer.
For those who begin treatment at 18 years old, their care will take place at the PTC.
Young people aged 18 to 24 years
Kingston Hospital adult cancer services do not offer care for young people aged 18 to 24 years. For these young people, urgent admission will be via the Kingston Hospital ED (Accident & Emergency). We will discuss this with you in more detail if this is relevant to your young person.
A member of the Kingston Hospital POSCU MDT, or the PTC, or your children’s community team, may ask your young person (or their family) to complete the Mefirst ‘Ready Steady Go Transition’ programme, to help support their transition (see More information).
More information
Me first Ready Steady Go Transition programme for young people
Macmillan Cancer Support: up to date cancer information for patients, relatives and carers
Momentum supports children and young people with cancer and life limiting conditions in Surrey and South West London
Children’s Cancer and Leukaemia Group: for patients and families
Young Lives Vs Cancer helps families cope with cancer
Blood Cancer UK: all types of blood cancer
Lymphoma Action: lymphatic cancer
Rays of Sunshine helps children with life limiting illnesses
The Brain Tumour Charity offers support to anyone affected by brain tumours
The Family Fund provides grants to low income families raising disabled and seriously ill children and young people
Kids Cancer Charity supports families of children with cancer
Teenage Cancer Trust helps teenagers fighting cancer
Children With Cancer gives support and advice on childhood cancer
Beads of Courage helps children coping with serious illness
Emily Ash Trust helps children and families who are coping with cancer
Dancing Eye Syndrome Trust helps children with the neuroblastoma complication called dancing eye syndrome
Histio UK helps people with Langerhans Cell Histiocytosis (LCH)
Make a Wish aims to grant magical wishes to children with life threatening conditions
Starlight aims to grant wishes and offer entertainment to seriously ill children
Dreamflight sends seriously ill children on a Florida theme park ‘Holiday of a Lifetime’
Contact information
POSCU MDT coordinator, Andrew Winrow Oncology Unit, Monday to Friday, 8.30am to 4.30pm.
Senior CNS and Specialist oncology sisters
Sunshine ward
Dolphin ward
PONT
Epsom community nurses
Hounslow Continuing Care team
Richmond community children's nurses
St George's community nurses
St Helier community nurses
Surrey community nurses
Blue badge parking
Telephone:
POSCU MDT coordinator, Andrew Winrow Oncology Unit: 020 8934 6374
Senior CNS and Specialist oncology sisters: 020 8934 6374
Sunshine ward: 020 8934 2325
Dolphin ward: 020 8934 2328
PONT: 020 8934 2327
Epsom community nurses: 01372 735 443
Hounslow Continuing Care team: 020 3903 3660
Richmond community children's nurses: 020 3903 3650
St George's community nurses: 020 8725 8222
St Helier community nurses: 020 8296 3075
Surrey community nurses: 01483 362 625