The Trinity St James’s Cancer Institute researcher Dr Naomi Algeo is a recipient of the 2022 Irish Cancer Society Allied Health Professional Cancer Research Award. Discussing her career progression and research interests, she talked to the Office of the Dean of Research about her experience working in both St James’s Hospital and Trinity College Dublin. In particular, she focused on her current research, identifying the support needs of adolescents and young adult (AYA) cancer survivors for successful return to education and work.

Algeo’s background in occupational therapy led directly into her current role. Throughout her career she has worked with many people whose daily lives are impacted by cancer treatment. Indeed, her PhD conducted in Trinity focused on cancer survivorship and vocational rehabilitation.

After working in various oncology roles in the UK, she joined St. James’s Hospital as a full-time occupational therapist in October 2021. She is also an adjunct assistant professor in the School of Medicine, Trinity College Dublin, where she is a co-investigator in a research team led by PI Prof. Deirdre Conolly, who was recently awarded Health Research Board’s Definition of Intervention and Feasibility (DIFA) award of €1million euro grant money to run trials for their Work and Cancer programme. She sits on the WHO Development Group for Cancer Rehabilitation, which establishes international requirements for cancer rehabilitation assessment and interventions.

As part of her Irish Cancer Society funded research, Algeo’s working week is spread across St, James’s and Trinity. Two and a half days a week she works in her clinical position, and for another two and a half days she conducts research in Trinity. Within the framework of this week, there is a considerable amount of experimentation at the intersection of research and clinical work. At the moment, she explains, there are no formal structures for clinical academic roles in Ireland for Health and Social Care Professionals (HSCPs). Thanks to the support of the Irish Cancer Society in tandem with St James’s SCOPe director, Alison Enright, they are testing these new roles.

Recently, she and her team set up a fatigue clinic to support patients following their cancer treatments. Her current focus is the cohort of adolescents and young adults (AYA). Her Irish Cancer Society award will enable her, as the project’s clinical lead, alongside Prof. Deirdre Connolly as the academic lead, to investigate support needs for AYAs in reintegration to education or work. This is particularly timely, Algeo explains, because St. James is about to establish a new service for that cohort, having been named as a designated centre in the National AYA Cancer Service Network.

Algeo is certainly working in a dynamic and evolving field. “Traditionally, if you look back maybe 10-15 years ago, we wouldn’t have been even having this conversation,” she reflects. “There has always been a huge focus on treatment, obviously necessarily so. But now that more and more people are living with and beyond cancer and surviving, there's a new focus now on cancer survivorship. Now we’re looking at how can we support people to live well, either with a cancer diagnosis or beyond a cancer diagnosis.”

Currently, the focus is still often discharge planning, ensuring that patients are going home safe and at a functional level. But Algeo believes there needs to be more emphasis on rehabilitating people, enhancing their functional statuses. “We have the skills to do that. But we need to have the manpower on the ground to be able to deliver an optimal service.”

Algeo and her team are now progressing this field of rehabilitation further for the 16-24 year age bracket, focusing on Leaving Cert and university reintegration, as well as reintegration for employment and volunteer roles. Currently they are seeking to develop a team of designated staff, based on the recommendation of the National Cancer Control Programme’s Psycho-Oncology Model of Care for children and AYAs.

Algeo’s interest in the area came from an initiative called “The Hangout,” a non-clinical monthly meeting for AYAs. Her team are exploring partnerships with start-ups and enterprises to create opportunities for internships, and to develop work experience that AYAs might have otherwise missed in terms of that skill, acquisition, or development. This ongoing project encouraged her to ask, “why can't we expand this and look at school and college?” AYAs, she points out, are often the “forgotten tribe,” in their transition from the children's hospital to adult services. “One young girl said to me that she feels like her arm is in Crumlin, and her leg is in St. James's. So I try to support them in this transition instead of working at silos.”

Algeo’s project has funding for 18 months, and clearly this is a burgeoning field where new frameworks are only beginning to be trialled, tested and established. What would she consider to be a successful implementation of her research? “From a clinical point of view,” she says, “I would love to see that every AYA in Ireland, or at least each one that come through St James's Hospital, is offered comprehensive holistic cancer, survivorship and rehabilitation care where needed to rebuild and move on with their lives.”

The integrative approach Algeo takes, and the outcomes she anticipates from her work, highlight the considerable advances occupational therapy offers to cancer survivors. Indeed, she suggests that there is a misconception about occupational therapy: “some people might have the perception that occupational therapist roles are confined to ‘oh, yeah, they gave my granny or my aunt a raised toilet seat or a piece of equipment.’ But as occupational therapists we're interested in function, in activities of daily living.” This is why she is interested in fatigue and cognitive impairments. “So yes, sometimes we will look at adapting the environment, but we’ll also consider adapting the task itself, or rehabilitating particular impairments that make independence in roles or activities challenging in the first place.”

Considering what advice she would give to anyone interested in combining clinical practice and research, she notes that St James’s Hospital is positioned ideally, sharing a campus with Trinity: “Sometimes, clinicians can feel intimidated by research. But what I'd remind people is that you're not expected to be an expert in research. And that's where we can really look at building on the relationship between Trinity and St James's.”

She suggests finding a mentor who is involved in research: “It doesn't have to be within your own discipline. I've had several people outside of occupational therapy speak with me about certain research opportunities. The more we work and talk together, the more we can share. We can grab those opportunities for St James's.”