About us

The Pain-related Complex Cancer Late Effects Rehabilitation Service (CCLERS) is a national, highly-specialised, multi-disciplinary rehabilitation service for adults experiencing severe, persistent pain and reduced physical function due to the consequences of treatment for cancer, including surgery, radiotherapy and chemotherapy. The service supports individuals living with pain-related cancer late effects from any type of cancer, including both solid tumours and blood cancers.

For more information on specific Referral Criteria – please click here

Who are we?

We are an internationally recognised, multi-disciplinary team made up of physiotherapists, occupational therapists, a health psychologist, a pain consultant, and a clinical nurse specialist. Together, we work to deliver comprehensive, person-centred care.

What is our goal?

CCLERS specialises in a non-medical management of complex persistent pain conditions by focusing on:

• Improving physical function and mobility
• Enhancing mental wellbeing
• Helping patients to develop strategies to better manage symptoms
• Supporting patients to engage in meaningful activities to improve their overall quality of life.

What are Complex Cancer Late Effects and what are the challenges?

Cancer late effects are long-term health issues that can arise months or even years after cancer treatment has ended. These effects are caused by damage to nerves, tissues, or organs resulting from chemotherapy, radiotherapy, or surgery. One of the most common and distressing late effects is persistent pain, which can significantly affect daily functioning and overall quality of life.

Pain-related cancer late effects involve ongoing pain due to nerve or tissue damage. However, the challenges extend far beyond pain alone.

Patients often experience a range of physical and cognitive symptoms, including fatigue, loss of physical function, mobility issues, difficulties with self-care, sleep disturbances, brain fog, and problems with concentration.

In addition to physical symptoms, cancer survivors may face emotional and psychological difficulties, such as fear of recurrence, anxiety, depression, feelings of guilt about surviving when others have not, and a profound sense of lost identity. Social isolation is also common, especially when individuals feel misunderstood or unsupported.

Patients referred to CCLERS often face specific challenges, including:

• Not Being Heard: Many survivors struggle to have their symptoms acknowledged. They are often told to move on because the cancer is “gone,” despite experiencing real and lasting issues.
• Stigma and Misunderstanding: Symptoms such as pain or fatigue are invisible and may not be immediately linked to cancer by others. They can emerge long after treatment, making it hard for patients to explain or validate their experience.
• Difficulty Accessing Specialised Care: Services for late effects are limited and not evenly distributed across the country. Many clinics focus only on specific types of treatment, like radiotherapy, and often have long waiting lists.
• Fragmented Care: Patients frequently have to coordinate between multiple services—such as pain management, physiotherapy, occupational therapy, and mental health support—without a centralised or joined-up approach. This can be overwhelming and discouraging.
• Lack of Awareness: Some healthcare professionals are unfamiliar with the long-term consequences of cancer treatment, which may result in missed opportunities for effective support or rehabilitation.
• Gaps in Emotional Support: The psychological impact of cancer late effects is often under-recognised. While physical recovery may be prioritised, mental health and emotional wellbeing are sometimes overlooked.

CCLERS aims to address these challenges by providing holistic, multi-disciplinary, specialised care for individuals experiencing pain-related cancer late effects—supporting not only their physical recovery but also their emotional and psychological wellbeing.

Our Pathway

Once a patient has been referred to CCLERS, they will be guided through a structured and supportive rehabilitation pathway designed to meet their individual needs.

Telephone triage

The journey typically begins with a telephone triage, where the clinical nurse specialist conducts an initial assessment to understand the patient's symptoms, challenges, and goals. This helps determine the most appropriate next steps in their care.

Multi-Disciplinary Team Clinic

Depending on the outcome of the triage, the patient may then be invited to attend a Multi-Disciplinary Team (MDT) clinic. During this clinic, they participate in 3 meetings: one with a pain consultant, one with physiotherapist and occupational therapist, and one with the health psychologist.

Rehabilitation Programme

If it is appropriate, the patient will be invited to participate to our Residential Rehabilitation Programme. This is a two-week, intensive programme that combines specialist physiotherapy, occupational therapy, psychology support, educational sessions, and therapeutic activities. Virtual delivery of this programme is also available for those who are unable to attend in person.

Follow-ups

Following initial intervention, we provide structured follow-up support to monitor progress and adjust the rehabilitation plan as needed. This includes a three-month follow-up with the clinical nurse specialist and a member of the therapy team, as well as further check-ins with the clinical nurse specialist at six and twelve months. Additional ad-hoc follow-ups can be arranged with the nurse or therapists depending on the patient's evolving needs.

What Is Offered in the Rehabilitation Programme?

The CCLERS rehabilitation programme offers a structured, holistic approach to help individuals manage persistent pain and its impact on daily life. The programme includes a mix of group and one-to-one sessions, designed to provide both education and practical tools for recovery, as well as emotional support.

Group sessions cover a wide range of topics to help patients understand their pain and build effective coping strategies. These include understanding what pain is, how pain medications work, the connection between mind and body, the role of stress, sleep, and pacing, and how to manage setbacks. Patients also explore tools for self-soothing, relaxation, creativity, communication, self-compassion, and managing unhelpful thoughts. These sessions also offer the valuable opportunity to connect with others who are experiencing similar challenges—helping patients feel less alone and supported through shared experiences.

One-to-one sessions with a physiotherapist, occupational therapist, and psychologist are tailored to each patient’s unique challenges. These sessions provide space to explore individual concerns and test practical, personalised solutions to improve daily functioning. Patients are supported to find approaches that work best for them and their lifestyle.

Movement-based therapies are also an important part of the programme. These include gentle yoga, guided movement sessions, and hydrotherapy. The warm water medium of Hydrotherapy provides a safe and supportive environment to explore range of motion, build confidence, and reconnect with the body in a positive way.

Overall, the rehabilitation programme is designed to support patients not only in managing their symptoms, but in rediscovering a sense of control, confidence, and connection in their lives.