Following on from Part One in May STRIDE, Sindhrani Dars continues to explore the role of the podiatrist when it comes to assessing, diagnosing and treating Chemotherapy Induced Peripheral Neuropathy (CIPN). Sindhrani explores the role of GPs in this picture, highlights key statistics and encourages more podiatrists to help by becoming involved in research opportunities.
You can listen to the full 20-minute audio recording below.
To pick up from where I left off in Part One, when I presented my research at the Australian Podiatry Conference I said to the attending podiatrists: if we see a person who is diagnosed with Chemotherapy Induced Peripheral Neuropathy (CIPN) and we know they are a cancer survivor – the best we can do is to educate them. Then the word spreads.
If every single clinician can talk to one person a day about how a podiatrist can make a difference to CIPN – someone who either has a family member/s with cancer, or they themselves have been through the journey of cancer – this is one of the best things we can do.
The reason being, if somebody is going through chemotherapy or they are a cancer survivor, they are usually part of some sort of group which is shared with other people who are going through the same situation. If they meet, they talk about it and so the word spreads. Word spreads so quickly.
Podiatrists can alleviate pressures off GPs and we need to educate people about this.
A simple neurovascular assessment can be made by a podiatrist, using our bedside table assessments – yet we need to let people know that we can do this. As mentioned in Part One, if nurse practitioners are aware of the role podiatrists can have – and if patients are aware, as well as oncologists – there will likely be a bit more compliance to see their podiatrist during their journey.
It’s much easier for a patient to get to see a podiatrist than a neurologist, or even a GP. If our GPs are made more aware of the role podiatrists can have in diagnosing and managing CIPN, they could focus their appointment on other urgent issues, knowing that the podiatrist can manage CIPN. We know that CIPN may persist way longer after chemotherapy finishes, more than five years. This is a real disconnect. The reasons for this disconnect are multifactorial. As I said, people with cancer are juggling with a lot of things. If they are going to see their GP, their focus tends to be on other greater priorities, obviously.
Whereas the GP could say to the patient: “Okay, right now in our appointment, this other pressing cancer-related issue is your priority. Yet, how about I slide that little podiatry brochure in for your CIPN, just to get assessed and see how things are.”
This GP education will be important because a lot of our referrals come from GPs, as the podiatrists in the Delphi study from Part One suggested. However, there is still a gap
There is a lot of work to do. Looking at just the chronic disease management plan referrals from the GP, we see there’s a need. In up to 60% of people who get CIPN, less than 20% of these people are seeing a podiatrist.
I would also encourage podiatrists to overcome any hesitancy to contact the oncologist – take that step and write that letter.
Say, “I have been seeing this patient for this number of years. I’ve done neurovascular assessments in the past and I’m aware that they have neuropathy or maybe they don’t have neuropathy.” Yet having that baseline assessment shared with the oncologist is a very good starting point to ensure our role is made clear in that initial diagnosis phase.
Then the oncologist or the practice nurses who are seeing these letters coming from podiatrists will recognise this and think, ‘Okay, I can involve their podiatrist [in this patient’s journey].’
Initially when I presented my research, I said, “Look, I know it’s an overwhelming journey.” We are looking at the person with cancer as a whole and they are dealing with a lot. Their whole life has changed. They’re having issues with simple tasks that used to be okay in their day-to-day living.
We understand that depression and anxiety kick in and mental health plays a big role when a person is going through a cancer journey. Yet if patients and other clinicians are made aware that some of it can be offloaded by podiatrists, then they would take that option. They would not deny it. Anything that helps. As podiatrists, we can help to support a patient’s independence and mobility, which has all sorts of mental health benefits.
In the Delphi study we conducted, we only had 26 podiatrists Australia-wide respond. I’m not complaining because I completely appreciate the busy schedules we have. That said, I think another role that we as podiatrists can play is to contribute towards the research when there’s an opportunity to have our say or to give our insight. And go from there. If we don’t participate, if we don’t speak up – then our whole profession is not going to be lifted up.
Overall, my key message is that we need to do better in our advocacy as podiatrists and in our patient advocacy overall. This means not being hesitant and sending those baseline assessments to nurse practitioners and oncologists, if we have patients with cancer.
I know podiatrists are busy, I get it. I’m a podiatrist as well and I work at a university, and it’s not easy. Yet if we seek the advocacy that we really want, we need to provide our input as podiatrists. We need to get this word out. Otherwise, there’s no point. Not just for my PhD’s sake, either. I don’t want to tick a box and say, “I’ve done my PhD.” I wanted to make an impact because that’s the reason I chose to do this. As an overall profession, we are making a difference in our patients’ lives but we can be making an even bigger difference.
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