Understanding renal cell carcinoma

May 3, 2022

Share this article

article hero thumbnail

What is renal cell carcinoma?

Kidney cancer is a cancer that starts in the cells of the kidney.1 Around 9 out of 10 kidney cancers are renal cell carcinoma (RCC). In the early stages of RCC the tumour is in the kidney only but as the cancer grows it can spread to other parts of the kidney and other parts of the body like the lungs or bones.1

Around
4,300

people in Australia were diagnosed with kidney cancer in 2021.*

Men accounted for
~67%

of cases.*

Projected to be the
7th

most diagnosed cancer in Australia in 2021.*

* AIHW, Cancer Data Australia 2021 https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents/cancer-summary-data-visualisation Accessed April 2022. Cancer in Australia 2021. https://www.aihw.gov.au/reports/cancer/cancer-in-australia-2021/summary

Who is at risk?

Some of the risk factors for kidney cancer include:1

  • Age (60+)
  • Smoking
  • Obesity
  • High blood pressure
  • Kidney failure
  • Family history
  • Inherited conditions
  • Exposure to toxic substances at work

Early detection & treatment

Most people with RCC do not have obvious symptoms and their cancer is discovered incidentally on imaging. This means that RCC is sometimes not found until the cancer is advanced. 2,3

Despite improvements in RCC diagnosis and treatment over the past two decades, it remains a serious urological malignancy. 4

If the cancer spreads or returns?

In the past five years, treatments for advanced RCC have evolved, including combination therapies, providing more options for patients.5,6

If you or a loved one are concerned about kidney cancer or renal cell carcinoma, it is important you talk to your doctor or healthcare team.

You can visit Cancer Australia for more information on the above statistics.

  1. Cancer Council Australia: Understanding Kidney Cancer Booklet, https://www.cancer.org.au/assets/pdf/understanding-kidney-cancer-booklet Accessed April 2022
  2. Padala S. A et al 2020, World J Oncol., ‘Epidemiology of Renal Cell Carcinoma’, vol. 11, no. 3, pp. 79-87, DOI: https://doi.org/10.14740/wjon1279.
  3. Atkins MD. Patient education: Renal cell carcinoma (kidney cancer) (Beyond the Basics). UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com/contents/renal-cell-carcinoma-kidney-cancer-beyond-the-basics Accessed April 2022
  4. Capitanio, Umberto et al. “Epidemiology of Renal Cell Carcinoma.” European urology vol. 75,1 (2019): 74-84. doi:10.1016/j.eururo.2018.08.036
  5. Ged, Y. et al 2020, Nature Reviews Urology, ‘Advanced renal cell carcinoma and COVID-19 — a personal perspective’, vol. 17, pp. 425-427, DOI: https://doi.org/10.14740/wjon1279.
  6. Schmidt, A. 2019, Asia-Pac J Clin Oncol, ‘Treatment selection for first-line metastatic renal cell carcinoma in Australia: Impact of new therapy options’, vo. 15, suppl. 10, DOI:10.1111/ajco.13289.
Our People

One Dad’s Parental Leave story at MSD

Why parental leave needs to be accessible to all parents

March 15, 2022

Share this article

article hero thumbnail

We are proud of our Parental Leave Policy that enables all parents at MSD to access Parental Leave regardless of their caregiver-status. Our Policy allows colleagues to take paid parental leave flexibly to suit the different needs of parents and their families. Our equitable Parental Leave policy is an important component of our commitment to gender equality both within and outside the workplace.

Our enhanced Parental Leave policy has been in place for nearly a year, and we are proud to hear of the impact that this policy has on our employees.

Dave Cushing, IT Site Lead at our MSD manufacturing facility in Bendigo, was particularly relieved to experience the real-life impact of the parental leave provisions that he was able to access at a very difficult time for his family, as he and his wife Jo welcomed their second son, Sully.

Dave and Jo’s Story, Welcoming Baby #2

Dave & Jo’s second child Sully had a challenging welcome into the world. Early on in pregnancy, Dave and Jo discovered their baby had some kidney issues and required regular scans. Later in the pregnancy, Jo’s 36-week scan indicated significant abnormalities, and their lives were quickly turned upside down. Sully was diagnosed with Congenital Diaphragmatic Hernia, impacting roughly 1 in 2500 births in Australia per year, with roughly a 20-30% mortality rate. Doctors requested that Jo and Dave immediately relocate to Melbourne (a 2 hour drive from home) to be near the critical care that would be required for Sully. At birth, Sully required resuscitation, emergency surgery and significant care in the RCH NICU. Following his surgery, it was not known what his prognosis would be, and how long he might need specialised extended care.

Throughout this scary time as they began to face this devastating diagnosis and the move away from home, Dave felt comforted knowing that one thing he would not have to worry about was receiving support from his leader and team as he started a leave of absence.

“It was no question in my mind that MSD would be there for me, to support me and my family.”

While Sully remained in NICU, Dave began thinking about what type of parental leave he would be eligible to take and what other types of leave he could use if Sully required extended care. When a teammate reminded him about MSD’s 12-week flexible parental leave policy, Dave recalls becoming teary, and the feeling of relief that had the time and space to deal with whatever is coming without worrying about whether he had enough leave.

Dave’s Parental Leave

Carer's leave
5 weeks

Throughout their stay in Melbourne, Dave was able to take carer's leave for the period of Sully's birth and NICU stay.

Full-Time Paid Parental Leave
6 weeks

When they returned home from Melbourne, Dave utilised full-time Parental Leave to settle back into home with Jo and their growing family.

Part-Time Paid Parental Leave
12 weeks

Dave felt he wanted to continue to be present for his family as they continued to adjust as a family of four. Dave decided to take the remaining eligible paid parental leave part-time. This allowed Dave to be caring for Sully and Hudson (2 years old) in the mornings and working in the afternoons as he eased back into work while remaining present with his family.

Through this time returning to work, Dave felt supported by MSD through all stages. He was able to embrace as he calls it: “ultimate flex”, adapting his work style to suit his growing family.

Where are they now?

Today, Sully is a happy and healthy 10-month-old boy and Dave and Jo are pleased to be watching him grow and develop through typical infant milestones, despite his challenging journey.

The importance of equitable Parental Leave

“MSD doesn’t just talk about caring for people. The company’s policies and values are reflected in actions. MSD is genuinely interested in the welfare of their people”
Dave Cushing, Proud Dad

Dave reflects that it is great to see the equal recognition of parenting at MSD, acknowledging the role of Dads and non-birthing partners in parenting, which enabled him to spend valuable time with his growing family.

Parental Leave doesn’t only impact the employee taking leave. The benefits of flexible, equitable paid parental leave extend to the employees family and community. For Jo, it was a welcome relief that Dave had the opportunity to spend time with family, as well as the assurance that his income would not be affected during an already challenging time with Sully, a young Hudson, all in the midst of the COVID lockdown.

“I felt relieved, it was such a weight off my shoulders knowing that we could just focus on Sully. Even after he left the NICU, he was still requiring a high level of care. I don’t know how I would have coped if Dave wasn’t around”.
Jo Cushing

Health Awareness

HPV-related cancers: What you need to know

Learn about human papillomavirus, or HPV, and the World Health Organisation's effort to eliminate cervical cancer as a public health problem

February 2, 2022

Share this article

article hero thumbnail

Did you know that human papillomavirus, or HPV, is a common virus? In fact, HPV infects most sexually active people in their lifetime.

For most people, HPV clears by itself. But, for those who do not clear the virus, it can cause certain cancers and diseases later in life. Unfortunately, there’s no way to know who will or will not clear the virus.

HPV can cause certain cancers and diseases in both men and women

In women, HPV can cause cervical, vaginal and vulvar cancer. In women and men, it can also cause genital warts, anal and oropharyngeal cancer (a type of cancer that can affect the back of the throat, including the base of the tongue and tonsils).

HPV-related cancers at a glance

~ 668K men and women worldwide are diagnosed with HPV-related cancers every year

In 2018, an estimated 1 in 25 cancers were caused by HPV

Cervical cancer is the 4th most common cancer in women worldwide

“HPV-related cancers are serious for both men and women. Fortunately, there are steps people can take to be proactive about their health. Men and women should speak with their health care providers to learn more about the link between HPV and certain cancers and diseases.”

Mel Kohn, M.D., M.P.H.,

Medical Director, MSD

The World Health Organization’s movement towards cervical cancer elimination

Important steps have been taken to achieve a world where fewer women are affected by cervical cancer, but more needs to be done

In 2020, the World Health Organization (WHO) launched its Global Strategy to accelerate the elimination of cervical cancer as a public health problem to build momentum for cervical cancer elimination around the world.

Achieving this goal will require collaboration and political support from international and local leaders, the private sector and the public.

Patients & Communities

6 global trends critical to patients during the COVID-19 pandemic

Expert panel of patient advocacy leaders on COVID-19, its impact on patients and moving forward

February 2, 2022

Share this article

article hero thumbnail

The ongoing COVID-19 pandemic has created unprecedented challenges around the world. It has significantly impacted health systems and health care. At the end of 2021, MSD hosted an expert panel of patient advocacy leaders from around the world to discuss shifts in health care and the impact on patients during the next phases of the pandemic. Special Report: COVID-19 and the Patient Perspective summarizes the panel conversation.

Moderated by MSD’s executive director of global patient advocacy, Michelle Vichnin, MD, the panel highlighted six global trends:

01.

Defining and characterising the “new normal”

New is the operative word.  Panelists note that everyone is learning something new, and resilience and agility are key as we respond to realities that are changing every day. And, this includes a new relationship with technology, which will likely deepen in the wake of COVID-19 and other crises, according to a recent survey.

02.

Understanding the future of patient care

The pandemic has forced health care systems to quickly adapt. Changes and trends in patient care include the adoption of telemedicine/telehealth and mobile delivery of care, increased use of technology for patient data and innovation in digital capabilities to monitor, diagnose and promote health.

03.

Challenges of COVID-19: focus on mental health

In addition to the loss of life and impact on physical health, COVID-19 has taken a toll on people’s mental health. Groups particularly affected include health and other frontline workers, students, people living alone and those with pre-existing mental health conditions.

04.

Addressing health care disparities and health equity

The pandemic has highlighted gaps in current health care systems and care models.  It’s forcing us, as a society, to grapple with health care disparities and aim for greater health equity. Panelists discussed some ways to improve those inequities, including addressing social determinants of health and building health literacy.


05.

Embracing patients and patient advocates as part of the solution

Because of what we’ve learned through the pandemic, there are opportunities for a renewed focus on health and prevention. This includes greater involvement of patients in all aspects of health care – from clinical trials to product development.

06.

Partnering for success

Collaboration across all sectors will be critical for addressing the enormous challenges that lie ahead and investment in health care should be prioritized. 

Read the report

Health Awareness

Understanding endometrial cancer

December 2, 2021

Share this article

article hero thumbnail

What is endometrial cancer?

Endometrial cancer arises from the lining of the uterus, which doctors refer to as the endometrium. The main symptoms are vaginal bleeding not related to menstruation and pelvic pain.

Endometrial carcinoma is the most common gynaecological cancer in Australia and is increasing in prevalence, and it is estimated that more than 3000 women would have been diagnosed with it in 2021.

Around
4,300

people in Australia were diagnosed with kidney cancer in 2021.*

Estimated to be the
5th

most common cancer in women

Find out more

Who is at risk?

Some of the risk factors for endometrial cancer are:

  • Obesity
  • Type 2 diabetes
  • Infertility associated with lack of ovulation
  • Late menopause
  • Postmenopausal medication containing oestrogen without progesterone, or oestrogen-producing tumours.
  • Genetic factors including Lynch syndrome and Cowden syndrome. Women with Lynch syndrome have an increased risk of developing endometrial cancer at a young age.

Early detection & treatment

The prognosis is good for women who receive treatment after being diagnosed with early-stage endometrial cancer. However, the outlook is poor if the cancer spreads or returns.

The doctor who treats endometrial cancer is usually a gynaecological oncologist, who will often work in a multidisciplinary team with other health professionals. The primary treatment is surgery, and your doctor will discuss what type of surgery is best for you. Other types of treatment may also be recommended before or after surgery.

If the cancer spreads or returns

A minority of patients will be diagnosed after their cancer has spread or will experience cancer that returns after initial treatment. In these cases, there is a high unmet need for effective treatments. However, recent advances in treatment options have opened options for women with advanced endometrial cancer.

If you or a loved one are concerned about endometrial cancer, it is important that you talk to your doctor or healthcare team.

You can visit Cancer Australia for more information on the above statistics.

Our People

Childhood cancer patient dedicates his life to clinical trial research

After participating in a paediatric leukemia study, Arjan Ooms’ life has come full circle as our director of clinical research in the Netherlands

November 19, 2021

Share this article

article hero thumbnail

On a day that should be filled with balloons, cake and presents, Arjan Ooms was in the hospital being diagnosed with leukemia. It was his fourth birthday.

Ooms was a relatively healthy young boy, but his parents started to worry when they noticed blue needle-size dots on his body.

“The moment I was diagnosed with ALL (acute lymphocytic leukemia), my life and that of my parents and the whole family was turned upside down.”

Arjan Ooms

Director, clinical research, the Netherlands

When Ooms was diagnosed with ALL in 1985, there weren’t nearly as many treatment options as today, and many included high doses of chemotherapy and radiation. After much consideration, Ooms’ parents decided to enroll their son in a clinical trial using an experimental treatment without radiation.

Although Ooms says he doesn’t remember much from his time as a paediatric patient, he does have memories of post-chemotherapy ice-cream treats, pet therapy visits and a meet and greet with Santa Claus.

Coming full circle

One year after his diagnosis, Ooms’ doctors told him he was in remission. But his journey with cancer wasn’t over just yet. The following years were filled with regular follow-up care appointments, and to this day, he still sees physicians to observe the long-term side effects of his childhood cancer as part of another clinical trial.

The importance of clinical trials has always stayed with Ooms. He went to college to study general health sciences and then started a career in clinical drug research in the pharmaceutical industry.

Today, he’s responsible for all clinical research activities for our company within the Netherlands — a position that coincidentally brought him back to the same hospital where he was treated as a young boy. Ooms was there to check in on a trial our company was conducting, but he took a moment to walk the halls and even stopped by his old hospital room that he says still had the same color paint on the walls.

“I saw kids moving around me in wheelchairs with their IV infusions on the back. Many had no hair on their heads, but they were smiling and laughing,” Ooms says. “At that moment, I realized, ‘Okay, I was also here when I was four years old, so let’s make sure I can give something back.”

Ooms says he also finds himself sharing his personal cancer story with his research teams to remind them of the impact their work has on so many different people.

“It’s not just a project, it’s a project where we can make a potential solution for a patient, and one that patients may benefit from in the future.”

Living life to the fullest

As a young boy, Ooms spent months in the hospital and sometimes in quarantine alone and away from his loved ones. He says turning off emotions was necessary to survive during that time, but today he has a different outlook on life.

“Now is the time that I truly value the real emotional connection,” says Ooms. “I want to get the most out of my life, and with my three young children, I’m also trying to make it clear to them how beautiful life is.”

Innovation

Harnessing tech to eliminate distance in a virtual world

An award-winning program has been key to our continued success despite limitations imposed by the COVID-19 pandemic

November 19, 2021

Share this article

article hero thumbnail

You never know how the world will change, so agility and innovation are key — especially when you’re inventing for life.

When the working world was upended in early 2020 by the COVID-19 pandemic, we already had plans in place to gradually expand our Remote Assist capability on smartglasses — a platform developed by our own teams that provides shop-floor personnel and scientists the ability to instantly collaborate hands-free with anyone in the world. Remote Assist operators can send real-time video and audio to colleagues anywhere in the world, allowing experts to diagnose mechanical or equipment issues remotely while leaving the operator’s hands free to perform any necessary tasks.

As the pandemic mushroomed and waves of mandatory stay-at-home orders necessitated adopting new ways of working, we accelerated the rollout, seizing the opportunity to become an industry leader in the adoption of Remote Assist. In doing so, research and manufacturing quickly adjusted to the new normal at more than 70 sites across six continents, divisional boundaries were broken down, and MSD’s Extended Reality Ecosystem was established.

article quote image

“Remote Assist helps us eliminate the barriers of geography, allowing colleagues to collaborate directly regardless of whether they’re on-site, working from home or on the other side of the world.”

Dave Williams

Chief information and digital officer

“It’s just one of the many tools that helps keep us inventing for life, even in unprecedented times,” says Dave.

And now, thanks to the successful adoption of Remote Assist, MSD has been recognized as a 2021 CIO 100 Award winner. These annual awards celebrate 100 organizations using IT in innovative ways to deliver business value. By delivering 21 months of scope in less than 9 months, Remote Assist helped save $3.6 million in travel costs and nearly 54,000 hours of employee travel across the company.

“This is just the beginning,” says Douglas Arnold, director, MSD Manufacturing Division-IT, client service leader and extended reality program lead. “We’ve built a great team, and together we are bringing innovation into production.”

Our People

Using data to drive impact for our customers and patients

Decisions at every step along the way are being driven by data and this is just the tip of the iceberg for MSD Australia

November 15, 2021

Share this article

article hero thumbnail

As the pharmaceutical sector continues to drive innovation in therapeutic areas, decisions at every step along the way are being driven by data. While some may be weary of what ‘big data’ represents, we believe it’s what organisations like ours do with data that drives impact for our customers and patients.

Decisions driven by data

Across our industry, traditional business strategy was to focus on product attributes and product offerings to drive commercial results. Now, with the availability of real-world data, we can make more targeted decisions when planning for products in our pipeline. Data is helping us with business planning, forecasting, resource optimisation, and customer engagement while at the same time, analysing the value chain of our business from the point of inception right through to our end user – our customers. The way we are now using data at MSD is intertwined with how we are running our business across Australia and New Zealand.

In the past, data may also have been used to inform an organisation’s marketing or financial strategy, but this is just the tip of the iceberg when it comes to the potential for data driven decision making. We are seeing a shift at MSD – there’s a real hunger for data to inform decisions in the areas of our policy and access team, clinical trials team, as well as medical teams, to name a few. While the focus of these areas differs to the way we would normally use data, our Advanced Analytics team is bringing together data sources from across the enterprise to help commercial and non-commercial teams make decisions that will positively impact their strategies.

article quote image

Our Advanced Analytics team is bringing together data sources from across the enterprise to help commercial and non-commercial teams make decisions that will positively impact their strategies.

Milind Bhamawat

Advanced Analytics and Digital Director

Enterprise problem solvers

You could say that the Advanced Analytics and Digital team are problem solvers for the enterprise – they are given a hypothesis to test and find the answer using data. The type of data they use ranges from our commercial data, to digital media and other online spaces. The analytics they apply help ensure they can be as targeted and as precise as possible in offering up our business solution.

“Our team at MSD is still scratching the surface of what data we have at our fingertips. But it is an exciting time to be leading this team and developing our data ecosystem, while working closely with teams across the organisation to translate business problems, into data analytics problems.”

As a data scientist, Milind Bhamawat will look at a business problem, and gets excited when he can make linkages back to data – “it’s a real ‘a-ha’ moment. My goal is to push MSD in the direction of using data to provide a long term view of where our company is heading, while realising the benefits we can reap from applying analytics across everything we do, and making faster decisions in the moment. I hope that this application will help us get our medicines to Australian & New Zealand patients more quickly than ever before. It may mean that we do things differently into the future – but, as a company driven by innovation – that’s what we are all about.” Milind Bhamawat, Director of Advanced Analytics and Digital for MSD Australia & New Zealand.

Health Awareness

The impact of family in managing type 2 diabetes

Family members can play an integral role in supporting their loved ones and helping them manage this chronic disease

November 12, 2021

Share this article

article hero thumbnail

Being diagnosed with type 2 diabetes can be emotional not only for the person diagnosed but for their family as well. It’s important to know, however, that family members can play an integral role in supporting their loved ones and helping them manage this chronic disease.

An estimated 463 million adults worldwide are living with diabetes.

It remains one of the most serious chronic health challenges we face today with global prevalence expected to rise to approximately 578 million adults by 2030. Type 2 diabetes is the most common type of diabetes, accounting for approximately 90-95% of all cases of diabetes of adults.

The importance of family in the care and management of type 2 diabetes

Type 2 diabetes is a chronic condition that requires education, regular monitoring and lifestyle changes, so family support is key in addition to working with your health care provider. When a loved one is diagnosed, family members can take steps to help support them in the care and management of the disease.

Adopt a healthy lifestyle

A key element of type 2 diabetes treatment is a healthy lifestyle, which includes a healthy diet and increased physical activity. If someone in your family is diagnosed, make an effort to follow the same healthy eating and physical activity plan as a sign of support, which may help improve your own health, too!

Educate yourself

While your family member learns new lifestyle management techniques and other important information about their diagnosis, it’s important for you to know the facts about type 2 diabetes to ensure you can be a strong ally in their care team.

  • Why and when blood sugar should be checked and how to recognise and handle the signs and symptoms of high or low blood sugar.
  • Know about A1C. A1C measures blood glucose over the past 2-3 months, and helps a health care provider determine how a treatment plan is working.
  • The recommended A1C goal for many adults with type 2 diabetes is less than 7%. Higher or lower A1C goals may be appropriate for other patients.
  • A health care provider should set an A1C goal that is right for your family member. Keeping on track with an A1C goal may help reduce the risk of diabetes complications, such as kidney disease or eye disease.

Go to appointments (but ask first)

If your family member feels comfortable with you attending their health care appointments, sitting in is a helpful way for you to learn more about how best to help them manage their type 2 diabetes. You can also offer support in other ways.

Stay positive

Managing type 2 diabetes can be overwhelming, but you can always lend encouragement and support by reminding your family member of their success and how proud you are of their progress.

Know the signs and symptoms of type 2 diabetes

Health Awareness

Routine doctor visits are down. Here’s why we shouldn’t skip them

November 4, 2021

Share this article

article hero thumbnail

Brittany Plavchak is a new mum and knows how important regular checkups are, not only to monitor milestones but to keep up with vaccination schedules.

Brittany is the director of global communications for vaccines and welcomed her first child into the world mere months before the COVID-19 pandemic. But when her son, Aidan, turned 4-months-old and was due for a doctor’s visit, Brittany and her husband were hesitant to bring him in.

Brittany Plavchak and her baby boy, Aidan

“In the past we never would have questioned going to the doctor, community health nurse or paediatrician. This time, we didn’t know what to do,” says Brittany.

Brittany wasn’t alone. During the peak of the COVID-19 pandemic, a lot of parents were unsure about what to do, while others chose not to bring their children to routine doctor visits. At the time, there were so many unknowns about the virus and how it spread, driving countries around the world to issue stay-at-home orders.

Ripple effects of COVID-19 on public health

Dr. Julie L. Gerberding, executive vice president and chief patient officer, says it’s vital for children to be up to date with their doctor and community health nurse visits, adding that adults need to keep up with their wellness appointments too.

According to a World Health Organisation pulse survey, from January through March 2021, about 94% of participating countries reported some kind of disruption to health services. Among the most affected were primary care, rehabilitative, palliative and long-term care.

“Too many people are not seeking the regular care they need, meaning preventive care as well as the management of other medical conditions that they might have,” says Julie.

article quote image

“It's especially important for people to understand the importance of preventive care, including immunisations and cancer screenings. They're missing critical opportunities to participate in the things that help them stay healthy, and that takes a toll.”

Dr. Julie L. Gerberding

Executive vice president and chief patient officer

Rescheduling cancer screenings

Adults in certain age groups need to be especially mindful about getting routine cancer screenings.

BreastScreen Australia is a joint initiative of the Australian and state and territory governments and aims to reduce illness and death from breast cancer by detecting the disease early. Women over 40 can have a free mammogram every 2 years and they actively invite women aged 50 to 74 to screen.

The National Bowel Cancer Screening Program aims to reduce deaths from bowel cancer by detecting the early signs of the disease. Eligible Australians from 50 to 74 years of age are sent a free, simple test that is done at home.

article quote image

“The concern is that a delay of diagnosis could lead to worse outcomes. The whole point of coming in for routine care is to have a more proactive approach for the prevention and early detection of cancer.

Dr Michelle Vichnin

Executive director, global patient advocacy and strategic alliances

 Supporting a return to care

More than a year into the pandemic, it’s important for the medical and public health community – including our company – to encourage people to get the routine care they need. We are reinforcing the importance of wellness among our employees and continue to do our part to improve the lives of patients from around the world. 

After being encouraged to maintain Aidan’s wellness appointment by their paediatrician, Brittany says she put her worries into perspective.

“My husband and I trust our doctor and were assured we would be safe during our visit,” Brittany says. “We ultimately decided we were more afraid of the consequences of our son going unprotected against other vaccine-preventable diseases.”

For people not sure how to get back on track, Julie suggests an easy first step: “Contact your GP or local doctors surgery, find out what services are available, which offices are open, and then make arrangements to catch up with the care that you might have missed.”