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When someone has dementia, routine treatments for cancer can cause major psychological disturbances – but thanks to award-winning nurse Lorraine Burgess, there could now be a safer way to bring these patients back to health.
Having worked for the UK’s National Health Service for fifty years, Ms Burgess has watched countless people with dementia undergo cancer treatment, amid a rise in this age-related comorbidity, and says the experience can sometimes do more harm than good.
“Even in non-neurological patients, it is common to get brain fog and confusion during chemotherapy – aka “chemo-brain” – and in people with dementia, this is pronounced,” she said.
Worse still are the disturbances involved in excising a tumour via surgery, as is common in melanoma treatment.
Typically, this surgery involves general anaesthesia and an overnight hospital stay – both of which can cause distress and delirium for people with dementia.
“Being in an unfamiliar environment, coupled with the side-effects of general anaesthetic, can be detrimental for them,” she said.
“Sometimes it can do serious long-term harm, and I’ve heard of people avoiding the surgery for this reason, which can lead to the cancer spreading and even claiming their life.”
A better way
Ms Burgess solved this issue with an idea she developed during a routine shift thirteen years ago.
“I had this gut feeling we could try removing the melanoma without general anaesthesia (GA) and just using a local one instead. That way, the patient wouldn’t need to stay overnight and could bypass those horrible GA side-effects,” she said.
Ms Burgess ran the idea past a surgeon, who seemed cautious at first.
“He was worried the patient may become distressed during the surgery and writhe around, which could make it difficult to remove the melanoma,” she said.
But with assurance that Ms Burgess would hold the patient’s hand throughout, the surgeon agreed to give it a try.
“Ultimately, I put my trust in him, and he put his trust in me,” she said.
A roaring success
Lorraine’s first patient was a 96-year-old man, who was having a melanoma removed on his leg.
“I sat with him, got to know him, got to know what type of music he liked. He liked Frank Sinatra. So, we played some of his music and I gave the patient lots of reassurance, telling him exactly what was going to happen next. He got through the surgery fine.”
Fast forward many years and Ms Burgess has been involved in around 700 of these unique surgeries, which have now become the norm for people with dementia or frailties at the UK hospital where she works.
“They come in on the day of their surgery, I meet and sit with them before they go in, stay by their bedside during the procedure, and then sit with them after when they go into recovery and give them some toast and tea.
“All of that happens within half a day, so they can go home. It’s a much better outcome for them.”
To date, Ms Burgess can only recall one occasion where the surgeon had to abandon the procedure due to patient distress.
“It became obvious right from the get-go that the surgery wouldn’t work for them and so we didn’t go ahead with it. But most patients cope with it just fine – they seem to just get through it.
“Some people, bless them, even fall asleep, which is really nice. You can’t get any more of a compliment than that for a surgeon.”
Communication skills are important
With decades of nursing experience behind her, Ms Burgess believes communication is one of her strengths and says this is key for distracting and reassuring patients.
“I ask questions and use the information they give me about themselves to get a conversation going. I hold their hand, sometimes we even sing together while they’re having the surgery.
“I also give a running commentary of what’s happening. I will say things like, ‘They’re just going to put that local anaesthetic in now and it might sting, but it’s only for a little while and we just need to numb the area’. Knowing what’s happening next keeps them calmer, rather than just sticking a needle in.”
While Ms Burgess is the main person responsible for delivering this care pathway, she says the model has worked well in other people’s hands.
“I have trained the theatre staff, because obviously I don’t work every day. So, we always have someone on standby. And they are all perfectly capable of creating that relaxed atmosphere for the patient.”
Cost saving
As well as giving patients better outcomes, Ms Burgess’s approach has saved the organisation hundreds of thousands of pounds, thanks to lower drug costs, and less time spent in the operating room and recovery.
This echoes a recent study, which found that switching from general to local anaesthetic in ambulatory settings could cut total surgery costs by around 23 per cent.
With these benefits in mind, Ms Burgess’s model has since gone on to win a Nursing Times Award and has already been deployed in another hospital in Manchester.
Meanwhile, the Greater Manchester Cancer Alliance board is trying to introduce the care pathway elsewhere in the region.
“It’s a model that can be deployed anywhere, providing staff are trained and everyone is on board,” Ms Burgess said.
Further insight
Sharing more on this innovative care pathway and a novel cancer training initiative she helped develop, Lorraine Burgess will present at the upcoming National Dementia Conference, hosted by Informa.
This year’s event will be held 28-29 April 2026 at the Crown Conference Centre Melbourne.
Learn more and register your tickets here.
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