Download acute oncology (including mscc) and cancer of unknown primary

ST. LUKE’S CANCER ALLIANCE
ACUTE ONCOLOGY (INCLUDING MSCC)
AND
CANCER OF UNKNOWN PRIMARY
TUMOUR SITE
SPECIFIC GROUP
Annual Report
(14-1C-104m/14-1E-104y)
2015-16
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ST. LUKE’S CANCER ALLIANCE
Acute Oncology and Cancer of Unknown Primary Tumour Site Specific
Group
The annual review has been agreed by:
Position
AOS Group & CUP Tumour Site Specific Group Chair
Name
Dr May Teoh
Royal Surrey County Hospital NHS Foundation Trust/Ashford and St. Peter’s
Hospitals NHS Foundation Trust
31st March 2016
Organisation
Date Agreed
AOS & CUP Group members agreed the Annual Review on
Date Agreed:
update
Originator of this evidence item:
Name
Title
Organisation
Address
Email
Telephone
Lorraine Sime
St Luke’s Cancer Alliance Manager
St. Luke’s Cancer Alliance
Royal Surrey County Hospital
Guildford
Surrey
GU2 7XX
[email protected]
01483 406750
Version Control:
Date
Version
16th
March 0.1
2015
28th April 2015 0.2
Status
Draft
Author
Lorraine Sime
Summary of changes
Initial Draft
Draft
Becky Clack
5th May 2015
0.3
Draft
Becky Clack
13th May 2015
1.0
Final
Becky Clack
Final
Sue Couzens
Updated by administrator of the
group
Updated with comments from Dr
May Teoh
Updated and finalised after
group meeting
Updated and finalised by May
Teoh after group meeting
31st March
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ST. LUKE’S CANCER ALLIANCE
1. Introduction

The St Luke’s Cancer Alliance has been established to provide a formal structure to deliver high
quality services with excellent clinical outcomes for patients and their families which are comparable
to results seen in Europe, Australia and the United States. The clinical network is based on patient
flows and comprises of three cancer units, one at Ashford & St Peter’s Hospitals NHS Foundation Trust
(ASPH), Frimley Health NHS Foundation Trust (FPH), and Surrey and Sussex Healthcare NHS Trust
(SaSH). Chemotherapy and Radiotherapy are provided by St Luke’s Cancer Centre (SLCC) which is the
designated Cancer Centre for the Alliance. The SLCC is providing chemotherapy closer to home at the
Ashford Hospital Site, Frimley Park Hospital and both chemotherapy and radiotherapy on the East
Surrey Hospital Site.

Centralisation of specialist surgery has been agreed across the Alliance and takes place at the Royal
Surrey County Hospital NHS Foundation Trust (RSCH) with complex renal surgery taking place at FPH.
The RSCH also provides services for Head & Neck and Prostate patients from North Hampshire
Hospitals NHS Foundation Trust. The population served by the Alliance is approximately 1.3 million
and replaces the previous Surrey West Sussex & Hampshire Cancer Network (SWSHCN). The Alliance
provides the infrastructure required to support and develop the clinical teams to ensure consistent
best practice, improve patient outcomes and the continuation of clinically safe services.

The 8 Clinical Commissioning Groups (CCGs) within the Alliance catchment area are in the process of
developing their Cancer Strategy’s in line with the NHS Outcomes Framework and Everyone Counts:
Planning for Patients 2012/13 and 2014/15-18. The alignment of these priorities with the Tumour Site
Specific Groups (TSSGs) will ensure that there is a coordinated approach to delivering a high standard
of care with a patient involvement strategy to ensure that patients are at the centre of service
developments.

Since the establishment of St Luke’s Cancer Alliance and appointment of an Alliance Groups Manager,
the Acute Oncology Service (AOS) (including Metastatic Spinal Cord Compression [MSCC]) and Cancer
of Unknown Primary (CUP) Tumour Site Specific Group (TSSG) have been meeting on a quarterly basis.
The group had previously agreed to merge the AOS (including MSCC) and CUP Alliance Groups and
hold joint meetings. The appointment of substantive AOS/CUP consultants at the cancer centre in
2014/2015 has enabled more comprehensive AOS/CUP services to be established in all 4 acute trusts
in the network.

This report covers the period March 2015 to April 2016. There have been 4 AOS (including MSCC)/CUP
TSSG meetings during this period.

Achievements:
- The Network CUP constitution has been reviewed and updated.
- The group has excellent engagement from all the Trusts within the Alliance and is a very
enthusiastic and hard working group, keen to improve the services.
- Completion of neutropenic sepsis audit (6 monthly), MSCC audit (annual) and CUP audit
(annual). Alliance agreed audits tools for neutropenic sepsis and MSCC have been
updated and agreed.
- Improved attendance at CUP MDT via videoconference and audio-linking facilities with
ASPH and SASH.
- Appointment of the CUP MDT lead
- Completion of local CUP patient survey
- Organisation of a regional (Network) MSCC educational half day for healthcare
professionals
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ST. LUKE’S CANCER ALLIANCE

- Presentations at national and international conferences
Challenges:
- Recruitment to the consultant histopathologist post as part of the Network CUP MDT
membership.
- No clinical trials currently available for CUP
2. Network Group Meetings (14-1C-103m/14-1E-103y)

The AOS (including MSCC) and CUP TSSG has met on a quarterly basis during 2015-16. This has been
facilitated by the appointment of an Alliance Group Manager in April 2014 as a result of the decision
by all providers to establish the St Luke’s Cancer Alliance following the end of the previous SWSH
Cancer Network.

Meeting dates during 2015/16 were as follows:
- 13th May 2015
- 23rd September 2015
- 8th December 2015
- 15th March 2016

See Appendix 1 for breakdown of attendance at meetings (14-1E-103y/14-1C-102m/14-1C-103m) and
Appendix 2 for minutes of the meetings.
3. Patient Experience (14-1C-109m)

A local patient experience survey to obtain feedback from CUP patients was developed and agreed
by the group. This was sent to a suitable patient cohort and a 75% response rate was obtained. The
results of the survey were discussed in the TSSG meeting on 15th March 2016. The overall feedback
was generally positive, however there were a few negative findings:
o Lack of written information on diagnosis
o Patients did not know who their Clinical Nurse Specialists (CNSs) were

While the National Cancer Patient Experience survey did not specifically report results for CUP
patients, a secondary analysis of the surveys in 2010, 2011-12 and 2013 conducted by a research team
at the University of Southampton has been recently published. The results of this analysis were
discussed at the TSSG meeting on 15th March 2016. The key findings largely mirrored the results of the
local survey, with the key messages on how to improve patient experience of:
o Access to CNSs
o Sufficient information about diagnosis and treatment options
o Coordinated care to prevent delays in investigations and treatment
o Continuity of care

Following on from the discussion at the TSSG meeting, the action points that were agreed were:
o Ensure each Trust had a patient information leaflet on CUP. At the present time, these
documents have been finalised and agreed in the local Trusts. The group agreed for these to
be distributed to appropriate patients as soon as possible.
o Ensure patients are made aware of who their CNS is. All the CNSs have individual cards with
their name and contact details, which are given to patients. The group agreed that patients
may require reminders as to who their CNS is.
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ST. LUKE’S CANCER ALLIANCE

While acknowledging that patient feedback for AOS/MSCC was not a peer review measure, the group
were keen to explore methods of capturing this in order to improve the service for patients. One
suggestion included obtaining feedback from the chemotherapy hotline at RSCH. The CNS team of the
TSSG will continue to discuss ways of obtaining patient feedback.

The Alliance is in the process of developing a website and patients, carers and relatives will be invited
to feedback via this route on specific service development.
4. Clinical Outcomes Indicators and Audits (14-1C-110m/14,1E-113y/14-1E114y/14-1E-115y)

The AOS (including MSCC) and CUP TSSG is committed to ensuring a continuous cycle of audit to
improve the patient experience and to develop services. The group have agreed the audit schedule
as follows:
o One Hour to Antibiotic (Neutropenic sepsis) Audit – to be presented once every 6 months
o MSCC Audits – to be presented annually
o CUP Audit – to be presented annually

At the meeting on 8th December 2015 a CUP audit was agreed, to review the number (proportion) of
CUP patients discussed in the MDT falling into each of histological subtype. The audit was presented
at the TSSG meeting on 15th March 2016. Out of the final analysis of 21 cases, these were the
confirmed histological subtypes:
o Adenocarcinoma 62%
o Squamous cell carcinoma 9%
o Neuroendocrine/carcinoid 14%
o Poorly differentiated carcinoma 5%
o Benign 10%
The “True CUP” rate was 16%, compared to 34% in historical controls from an audit conducted in
2014/15. The audit concluded that increased histopathological support for the CUP MDT have
significantly increased the proportion of patients whose primary tumour is identified and reduced
the number of patients being treated as CUP, which should lead to an improvement in outcomes.

The One Hour to Antibiotic (Neutropenic Sepsis) Audit was discussed at the meeting on 23rd
September 2015 and it was agreed that data would be collected for January 2015 – June 2015 and
that each Trust would present their results at the meeting on 8th December 2015.

At the meeting on 8th December 2015, each Trust presented their results:
- ASPH
The time frame reviewed was Jan – Sep 2015. The total number of suspected neutropenic sepsis
(NS) patients was 68, with 27 confirmed NS (approximately 30% were haematology cases). The
average door to needle time was 68.9min and average percentage receiving antibiotics within 1
hour was 59%. However when the results were analysed according to each quarter, there was an
improvement in results (average door to needle time 83.7min in Q1 compared to 54.6min in Q3;
average percentage receiving antibiotics within 1 hour was 52.9% in Q1 compared to 85.7% in
Q3).
FPH
No results were presented.
- RSCH
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ST. LUKE’S CANCER ALLIANCE
-
The total number of suspected NS cases was 33, with 18 confirmed NS. Approximately 30% were
haematology cases. The average door to needle time was 79min and average percentage
receiving antibiotics within 1 hour was 42.3%. There is delay between nurse and doctor review.
SASH
The total number of suspected NS cases was 42, with confirmed NS in 23. The median door to
needle time was 82min and average percentage receiving antibiotics within 1 hour was 36%.
Overall the results showed a slight improvement across the trusts, compared with the results of the
previous audit period. The group acknowledged the importance of continuing education and training
of frontline A&E/medical staff. The updated neutropenic sepsis pathway has been discussed and
ratified.

The network MSCC audits were discussed at the meeting on 13th May 2015 and it was agreed data
would be collected for March 2015 – August 2015 and that each Trust would present their results at
the meeting on 23rd September 2015.

At the meeting on 23rd September 2015, RSCH, ASPH and SASH presented their results. FPH presented
their results at the meeting on 15th March 2016:
- ASPH
17 patients were included in the audit. 76% had imaging within 24 hours of request. 71% were
referred to MSCC coordinator/neurosurgeons. Treatment was commenced within 24 hours for
33% and within 48 hours for 89%
- FPH
7 patients were included in the audit. 72% had imaging within 24 hours of request. 100% were
referred to neurosurgeons. Treatment was commenced within 24 hours for 58%.
- RSCH
35 patients had suspected MSCC. However data was only available for 7 patients. 57% had
imaging within 24 hours of request.
- SASH
30 patients were included in the audit (15 confirmed MSCC). 63% had imaging within 24 hours of
request. 73% were referred to MSCC coordinator/neurosurgeons. From confirmation of MSCC,
the average wait time to surgery was 5 days and to radiotherapy was 1.9 days.
The group agreed that more education and training for all healthcare professionals was required to
ensure all aspects of the MSCC pathway is adhered to. The updated MSCC pathway has been
discussed and ratified.
5. Discussion of Clinical Trials (14-1C-111m)

There are currently no interventional clinical trials in the National and local Research Portfolio which
are specifically designed for CUP.

All MUO patients presenting via the CUP MDT who are ultimately classified as cancer arising from a
particular primary site would be considered for site specific clinical trials in the St Luke’s Cancer
Alliance portfolio. In addition, suitable patients presenting via the CUP MDT are referred to the Surrey
Clinical Research Centre, or other Phase I Units, for consideration of early phase clinical trials.

The CUP MDT and TSSG will:
- Work with Kent, Surrey and Sussex Clinical Research Network to review availability of suitable
trials for CUP patients and liaise with colleagues in other hospitals regarding any local
projects/clinical studies for CUP patients.
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ST. LUKE’S CANCER ALLIANCE
-
Work with Surrey Clinical Research Centre to identify phase 1 trials suitable for CUP patients.
Explore the possibility of forming a tissue bank of unknown primary tumours and genomic
information.
6. Research, Publications and Presentations of TSSG members
Poster presentation:
An analysis of the clinical features associated with newly diagnosed cancers presenting as emergencies at
a UK district general hospital. Authors: May Teoh, Faithe Cockroft, Sian Wing, Alaaeldin Shablak, Ahmed
Abdelaziz, Sarah Burton.
National Acute Oncology Conference Birmingham (October 2015)
Poster presentation:
A review of the investigative pathway for cancer of unknown primary (CUP): the need for improved
diagnostic techniques. Authors: May Teoh, Simon Page, Peter Borlase, Nita Patel, Eirini Thanopoulou. NCRI
Conference (November 2015)
Poster presentation:
Streamlining a chemotherapy triage helpline within the Acute Oncology Service (AOS). Authors: May
Teoh, Agnieszka Kehinde, Samatha Russell, Julia Whittle, Amanda Houston, Stephanie Wynter, Simon
Page, Victoria Mumford.
NCRI Conference (November 2015)
Oral Presentation:
Importance of the CNS role in cancer care. Speaker: Agnieszka Kehinde.
Greece national cancer conference
Agnieszka Kehinde has also been a speaker on ‘Acute Oncology’ at the Practice Nurses Course (June 2015)
and on “Role of Acute Oncology’ at the Cancer Awareness Course (Dec 2015)
Regional MSCC Educational Half Day (RSCH, February 2016):
Organiser: May Teoh. Presentation topics:
 Surgical treatment of MSCC. Speaker: Matthew Crocker (St George’s Hospital)
 The role of the MSCC coordinator and MSCC pathway update. Speaker: Pamela Floyd (St George’s
Hospital)
 MSCC audits/data activity. Speaker: Matthew Crocker, Pamela Floyd, May Teoh

Physiotherapy and Spinal Rehabilitation for MSCC. Speaker: David Griffin-Mead (RSCH)
Oral Presentation:
A review of the investigative pathway for cancer of unknown primary (CUP): the need for improved
diagnostic techniques. Authors: May Teoh, Simon Page, Peter Borlase, Nita Patel, Eirini Thanopoulou.
Cancer of Unknown Primary Pathway Development conference Birmingham (March 2016)
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ST. LUKE’S CANCER ALLIANCE
APPENDIX 1
AOS (including MSCC) & CUP TSSG Attendance Summary 2015/16
NAME
Designation
Role in TSSG
Date
rd
ASHFORD AND ST. PETER'S HOSPITAL
Medical
th
13 May
2015
23
Sep
2015
8 Dec
2015
15
Mar
2016
Extended member
N
N/A
N/A
N/A
Core Member (CUP/AO)
Y
Y
Y
N
Core Member (AO)
N
N
N
N
Core Member - Chair/Trust AO Lead
Y
Y
Y
Y
Core Member - Network CUP/CUP
MDT lead (from Sep 2015)
N/A
N
Y
Y
th
th
Alaeeldin Shablak
Locum Consultant
Oncologist
Faithe Cockcroft
AOS/CUP CNS
Jacqueline Ince
Consultant
Physician
Acute Medicine
May Teoh
RSCH)
(also
Consultant
Oncologist
Clinical
Madeleine Hewish
(also RSCH)
Consultant
Oncologist
Medical
Sarah Burton
Lead Cancer Nurse
Extended member
N
N
N
N
Sian Wing
AOS/CUP CNS
Extended member
Y
Y
Y
N
in
FRIMLEY PARK HOSPITAL
Adrian
Franklin
(also RSCH)
Locum Consultant Clinical
Oncologist
Extended member
N/A
N/A
N
Y
Ajay Mehta
Consultant
Oncologist
Extended member
Y
N
N
N
Dhruv Patel
Consultant Radiologist
Extended member
N
N
N
N
Joseph Peralta
AOS/CUP CNS
Core Member (CUP/AO) - Nurse
member of MDT (shared with SS)
N
N
N
N
Maria
Hardo
Consultant Histopathologist
Extended member
N
N
N
N
Nick Dando
Consultant
Medicine
Extended member
N
N
N
N
Nita Patel
Consultant
Oncologist
Core
Member
Trust
AO
Lead/Network MSCC Lead (M/L
from Dec 2015)
Y
Y
Y
N/A
Shobana
Srinivasan
AOS/CUP CNS
Core Member (CUP/AO) - Nurse
member of MDT (shared with JP)
N
N
N
N/A
Simon Gifford
Cancer Services Manager
Extended member
N
N
N
N
Core Member (CUP/AO) - Nurse
member of MDT/User Issues
(shared with SR)
N
Y
N
Y
Core Member (CUP)
N
N
N
N
Extended member
N
N
N
Y
Bahhadi-
Clinical
in
Palliative
Clinical
ROYAL SURREY COUNTY HOSPITAL
Aga Kehinde
AOS/CUP CNS
Andrew Davies
Consultant
Medicine
Carol Redfern
in
Palliative
Trust Head of Cancer
Nursing and Patient Support
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ST. LUKE’S CANCER ALLIANCE
Services
David Griffin-Mead
Team Leader Oncology Macmillan Physiotherapist
Core Member (AO)
Y
Y
Y
N
Emma Highton
AOS CNS
Extended member (M/L from Dec
2015)
N/A
N/A
Y
N/A
Helen Bennett
Cancer Services Manager
Extended member
N
N
N
N/A
Jane Dickie
Cancer Quality Manager
Extended member
Y
Y
Y
Y
John de Vos
Consultant
Haematologist/
Clinical Director for Oncology
Core Member (AO) - Chair of
Network Chemotherapy Meeting
N
N
N
Y
Julia Whittle
AOS CNS
Extended member
N
N
N/A
N/A
Katie Read
Review
radiographer
(Radiotherapy)
Extended member
N/A
N/A
N/A
Y
Lauren Webb
Specialty Manager Oncology
& Gynae Oncology
Extended member
N
N
N
N
Martin Al Soof
Locum
Consultant
in
Emergency
Medicine/ED
Lead for Oncology
Core Member (AO)
Y
Y
Y
Y
Peter Borlase
Cancer Services Manager
Extended member
N/A
N/A
N/A
Y
Rebecca Flint
Review
radiographer
(Radiotherapy)
Extended member
N/A
N/A
N/A
Y
Richard Shaffer
Consultant
Oncologist
Core Member (AO) - Chair of
Network
Radiotherapy
Meeting
(from March 2016)
N/A
N/A
N/A
N
Sally Seymour
Deputy Chief Pharmacist
(Cancer, Aseptic & Research
Services)
Core Member (AO)
N
N
N
N
Sam Russell
AOS/CUP CNS
Core Member (CUP/AO) - Nurse
member of MDT/User Issues
(shared with AK)
N
N
Y
Y
Sarah Watson
Consultant Radiologist
Core Member (CUP)
N
N
N
N
Sebastian
Cummins
Clinical Director for Oncology
Extended member
N
N
N
N/A
Simon Page
Associate Specialty Doctor
Extended member
Y
N/A
N/A
N/A
Stephanie
Assuncao
AOS CNS
Extended member
N/A
N/A
N/A
Y
Stephanie Wynter
Secretary to AOS/CUP team
Extended member
Y
N
N
Y
Thiagarajah
Balamurugan
SpR Histopathology
Extended member
N/A
N/A
N/A
Y
Veni Ezhil
Consultant
Oncologist
Core Member (AO) - Chair of
Network Radiotherapy Meeting (until
Feb 2016)
N
N
N
N/A
Clinical
Clinical
ST. GEORGE'S HOSPITAL
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ST. LUKE’S CANCER ALLIANCE
George Eralil
Locum
Neurosurgeon
Consultant
Pamela Floyd
Spinal
Specialist/MSCC
Coordinator
Bijal Pandya
Service
Management
Assistant - Neurosciences
Nurse
Core Member (AO/MSCC) (shared
with PF)
Y
N
N
N
Core Member (AO/MSCC) (shared
with GE)
Y
N
N
N
Extended member
Y
N
N
N
Core Member -Trust AO Lead
N
Y
Y
Y
SURREY AND SUSSEX HOSPITALS
Eirini Thanopoulou
(also RSCH)
Consultant
Oncologist
Medical
Jane Penny
Lead Cancer Nurse
Extended member
N
N
N
Y
Lisa Jacques
AOS/CUP CNS
Core Member (CUP/AO)
Y
Y
Y
Y
Tina Brown
Cancer Services Manager
Extended member
N
N
N
N
Tina Dela-Cruz
AOS/CUP CNS
Extended member
N
N
N
N
ST. LUKE'S CANCER ALLIANCE
Becky Clack
Alliance Groups Manager
Secretarial/Admin Support (until May
2015)
Y
N/A
N/A
N/A
Jayshri Shetty
Alliance Groups Manager
Extended member
N/A
Y
Y
N
Lorraine Sime
Alliance Manager
Extended member
Y
Y
Y
Y
Marianne Illsley
Alliance Medical Lead
Extended member
N
N
N
N
Sue Couzens
Alliance Groups Manager
Secretarial/Admin
May 2015)
Y
Y
Y
Y
Extended member
Y
N
Y
Y
Support
(from
GP COMMISSIONERS
Karen Jones
Macmillan GP
Patient Representatives
1 representative*
None
Core Member
N/A
N/A
N/A
N/A
1 representative*
None
Core Member
N/A
N/A
N/A
N/A
*Please note patient views are collected to inform service developments and improvements by
participation by all Trusts in the National Patient Experience Survey (NPES)
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ST. LUKE’S CANCER ALLIANCE
APPENDIX 2
Agenda and Minutes from 2015/16 Meetings
ALLIANCE AOS/CUP GROUP MEETING
Wednesday 13th May 2015
3:30pm – 5pm
Room A4, Post Graduate Education Centre, Royal Surrey
County Hospital
Attended:
May Teoh (CHAIR) (MT)
Sian Wing (SW)
Faithe Cockroft (FC)
Nita Patel (NP)
Jane Dickie (JD)
Consultant Clinical Oncologist
AOS CNS
AOS CNS
Consultant Clinical Oncologist
Cancer Quality Manager
Karen Jones (KJ)
Macmillan GP
Ajay Mehta (AM)
Pamela Floyd (PF)
Lisa Jacques (LJ)
Lorraine Sime (LS)
Becky Clack ( (BC)
Sue Couzens minutes (SC)
Consultant Medical Oncologist
Locum
Consultant
in
Emergency
Medicine/ED Lead for Oncology
Team Leader Oncology - Macmillan
Physiotherapist
Secretary to RSCH MOU & CUP/AOS
Associate Specialty Doctor
Locum Consultant Neurosurgeon
Service
Management
Assistant
Neurosciences
Spinal Nurse Specialist/MSCC Coordinator
AOS CNS
Alliance Manager
Alliance Groups Manager
Alliance Groups Manager
Apologies:
Andrew Davies (AD)
Helen Bennett (HB)
John de Vos (JdV)
Sam Russell (SR)
Sarah Watson (SW)
Eirini Thanopoulou (ET)
Joseph Peralta (JP)
Simon Gifford (SG)
Consultant in Palliative Medicine
Cancer Services Manager
Consultant Haematologist
Acute Oncology CNS
Consultant Radiologist
Consultant Medical Oncologist
AOS Nurse
Cancer Services Manager
Martin Al Soof (MAS)
David Griffin-Mead (DGM)
Stephanie Wynter (SW)
Simon Page (SP)
George Eralil (GE)
Bijal Pandya (BP)
ASPH/RSCH
ASPH
ASPH
FPH/RSCH
RSCH
Guildford
and
Waverley CCG
FPH/RSCH
RSCH
RSCH
RSCH
RSCH
SGH
SGH
SGH
SASH
SLCA
SLCA
RSCH
RSCH
RSCH
RSCH
RSCH
RSCH
SASH/RSCH
FPH
FPH
MINUTES
Action
1.
1.1
Welcome and Apologies
MT welcomed everyone to the meeting and apologies were listed for the minutes.
2.
2.1
Minutes from the Previous Meeting on 11th March 2015
The minutes were reviewed and agreed.
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ST. LUKE’S CANCER ALLIANCE
2.2
Item 3.2– histopathology recruitment – went out for advert in January 2015 but was
unsuccessful in recruiting. Interviews are now planned for 1st July. Dr Bagwan has
agreed to cover until a new consultant is in post in September.
3.
3.1
MSCC
Discuss pathway with SGH: There was a meeting at SGH which some people
attended which was useful in terms of clarifying the referral process. SGH had the
best record for turnaround time in London.
3.2
London Cancer Alliance is pushing for SGH to have a single point of contact but this
is a long way off. Will be changing bleep numbers soon.
3.3
It was clarified that the MSCC Co-ordinator is the best point of contact between the
hours of 9am-5pm, Monday-Friday. Out of hours there is an on call Clinical
Oncology Registrar. Would be best to refer during working hours unless the patient
is almost certainly experiencing cord compression and trusts to bleep PF when
sending referral through so she is aware it is coming.
3.4
SGH planning on going out to all referring trusts for a grand round.
3.5
SGH currently have a Neuro-onc MDT and also a Spine MDT. Once an Oncologist
is in place then the MSCC patients will move over.
3.6
Alliance SOP: It was suggested that this should be named as a Policy. A draft has
been circulated, which includes the responsibilities of MSCC co-coordinator,
Rehabilitation and patient information. BC to circulate.
BC
3.7
There is an MSCC half day on 28/5 1-4pm at SGH.
3.8
Discussed SGH Treatment Algorithm for MSCC – fax number for RSCH to be
removed so it’s email only.
3.9
Audits – one database would be very useful; currently systems are not connected
and central access would be preferable. It was suggested that all use the same
excel sheet to be filled in to one central place every 3 months.
4.
4.1
Neutropenic Sepsis Pathway
MT has drafted a new pathway for discussion. SASH has agreed to pilot the
pathway in which there is a change in the way that patients are currently managed.
Group agreed to keep the current pathway in the constitution and then will revisit
the possibility of moving to the new pathway after feedback from the SASH pilot.
Will also need discussions with all oncologists. BC to update constitution.
4.2
There was mention that the MASSC scoring system was confusing and so training
would be needed if this was introduced.
5.
5.1
Treatment Protocols
BC circulated prior to the meeting. Any comments to be sent back to BC for
inclusion in the constitution.
6.
6.1
CUP Audit Presentation
SP presented an audit on 2014 CUP patients which reviewed how many MUO/CUP
patients received PET scans (attached to the minutes).
BC
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ST. LUKE’S CANCER ALLIANCE
6.2
The group acknowledged they needed to agree a CUP audit for 2015/2016. All
agreed to consider topics for agreement at the next meeting in September 2015.
BC to circulate the Appendix from the measures, which suggests possible BC
CUP audits.
7.
7.1
Audits
Future audit presentation dates will be decided at the next meeting in September.
7.2
MSCC audits - the group felt just 3 months data collection may not be enough for
any useful results and so agreed to collect until August, which would be 6 months of
data, for presentation at the meeting in September.
7.3
Netropenic Sepsis – completed on a rolling basis. Will agree which meeting to
present this at during the September meeting.
8.
8.1
Patient Experience Feedback
The results from the National Cancer Patient Experience Survey 2014 have been
published but there were no individual results for CUP patients. Therefore, the
group agreed they needed to develop a method of capturing patient feedback. The
group agreed to liaise with colleagues at other trusts to see how they capture
patient experience. They would then use this information to design and distribute a
survey to capture CUP patients’ feedback.
8.2
They acknowledged that patient feedback was not a peer review measure for
AOS/MSCC but the group were keen to work out a method of capturing this in order
to improve the service for patients.
9.
9.1
Peer Review Documents
BC has circulated the AOS/MSCC and CUP constitutions and a combined annual
report and work programme.
9.2
All members to send any comments to BC by the end of the week.
BC
10.
Any Other Business/Dates of Future Meetings
10.1 LS informed the group that it was BCs last meeting and thanks was given for all her
help with the group.
10.2 The date for the next meeting was agreed.
Future Dates: Wednesday 23rd September, 2.30-4.30pm, Venue to be arranged.
13
ST. LUKE’S CANCER ALLIANCE
ALLIANCE AOS/CUP GROUP MEETING
Wednesday 23 September 2015
2:30pm – 4:30 pm
Bowel Screening Hub, Surrey Research Park,
20 Priestley Road, GU2 7YS
Attended:
May Teoh (CHAIR) (MT)
Consultant Clinical Oncologist
ASPH/RSCH
Sian Wing (SW)
AOS CNS
ASPH
Faithe Cockroft (FC)
AOS CNS
ASPH
Nita Patel (NP)
Consultant Clinical Oncologist
FPH/RSCH
Jane Dickie (JD)
Cancer Quality Manager
RSCH
Aga Kehinde
AOS Nurse
RSCH
Martin Al Soof (MAS)
Locum
Consultant
in
Emergency
RSCH
Medicine/ED Lead for Oncology
David Griffin-Mead (DGM)
Team Leader
Physiotherapist
Eirini Thanopoulou
Consultant Medical Oncologist
SGH
Lisa Jacques (LJ)
AOS CNS
SASH
Lorraine Sime (LS)
Alliance Manager
SLCA
Jayshri Shetty (JS) part
Alliance Groups Manager
SLCA
Sue Couzens minutes (SC)
Alliance Groups Manager
RSCH
Apologies:
Andrew Davies (AD)
Consultant in Palliative Medicine
RSCH
Carol Redfern (CR)
Trust Head of Cancer Nursing and Patient
Support Services
RSCH
Helen Bennett (HB)
Cancer Services Manager
RSCH
John de Vos (JdV)
Consultant Haematologist
RSCH
Sam Russell (SR)
Acute Oncology CNS
RSCH
Sarah Watson (SW)
Consultant Radiologist
RSCH
Stephanie Wynter
Secretary to RSCH MOU & CUP team
RSCH
Oncology
-
Macmillan
RSCH
14
ST. LUKE’S CANCER ALLIANCE
George Erali (GE)
Locum Consultant Neurosurgeon
SGH
Pamela Floyd (PF)
Spinal Nurse Specialist/MSCC Coordinator
SGH
Joseph Peralta (JP)
AOS Nurse
FPH
Simon Gifford (SG)
Cancer Services Manager
FPH
Shobana Srinivasan (SS)
AOS Nurse
FPH
MINUTES
Action
1.
1.1
Welcome and Apologies
MT welcomed everyone to the meeting and apologies were listed for the minutes.
2.
2.1
Minutes from the Previous Meeting on 13th May 2015
2.2
The minutes were reviewed and agreed.
Item 2.2– histopathology recruitment, there has been recruitment for only one of two
posts and the new Consultant has presently has been allocated to another MDT. Dr
Bagwan has agreed to provide consultant cover and has allocated a final year
registrar to attend the MDT. MT to check allocation of Histopatholgist and get
update from Dr Bagwan.
MT
3
MSCC Audits - were presented by ASPH, RSCH and SASH.(Attached with
minutes) FPH were not ready to present at this meeting
15
ST. LUKE’S CANCER ALLIANCE
4.1
MSCC audit discussion/SOP
There was discussion around how to capture patients for the audit. One suggestion
was whether a list of patients could be obtained from MRI. In RSCH, it was
suggested that the MSCC patients would be highlighted in the daily morning board
round as any patients with suspected MSCC would have been admitted i.e. would
be inpatients.
4.2
The audit from SASH highlighted that there might be variations in how the MRI is
reported. This was also confirmed to be an issue at the other trusts.
All teams to contact local radiology department at individual trusts to discuss
how MRIs are reported.
4.3
4.4
ALL
The group felt that the MSCC patient information leaflets were not suitable to be
given to all patients at risk of MSCC (may cause anxiety to patients). There was a
suggestion to use the patient information leaflet for patients who had confirmed
MSCC and use the patient alert card for patients who are at risk of MSCC. Once
documents agreed, the alert cards and leaflets should be distributed to the clinics to
be given to patients. AK raised the issue that CNSs can be reluctant to give out
cards to patients, especially if the doctors had not previously discussed MSCC with
the patients. All agreed however that it is important to ensure cards are given to the
appropriate patients.
AK will discuss the distribution of alert cards with CR at next CNS meeting.
AK
MT to review and update patient information leaflet and alert card.
MT
LJ to review the MSCC audit tool.
LJ
MSCC SOP
A draft of the SOP has been circulated. Any comments to be fed back to MT in
two weeks
ALL
4.5.
SGH have set up a Spine MDT (which is separate from the Neuro-oncology MDT.
MSCC patients are now discussed at the Spine MDT which takes place at 8am on
Fridays. They would like a representative from RSCH to attend but currently there is
no availability in the existing job plans of the clinical oncology AOS consultants.
MT to discuss this with Lauren Webb
MT
5
5.1
Neutropenic Sepsis Pathway
MT has discussed the updated Neutropenic Sepsis pathway at Consultants
meeting. There is a discrepancy in the definition of neutropenia used in the pathway
at SASH and other trusts in the Network. SASH would like to continue with their
pathway. A consensus could not be reached in the group regarding a uniform
MT
definition of neutropenia to be used in the network for the pathway
MT suggested meeting with MI/AS to discuss
5.2
Neutropenic Sepsis audit – continue to collect data prospectively on a rolling basis.
Audit data for January – June 2015 to be presented at the December NAOG
meeting).
ALL
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ST. LUKE’S CANCER ALLIANCE
6.
CUP Audit
Suggested Audits from the measures were discussed and the group agreed a CUP
Audit for 2015/16, which is:
The number (proportion) of patients from the cCUP population, falling into each
histological subtype.
MT suggested that a trainee/junior doctor could help to collect the data. Patients to
be included in the audit will be selected from the CUP MDT lists from 2015. The aim
would be for the audit to be presented at March NAOG meeting.
7
CUP/MUO Pathway
There will be changes in terms of personnel. NP will be on Maternity leave from
next week. It is planned that MH will take over as CUP MDT lead. There was
discussion regarding strategy for treating CUP patients and developing agreed
protocols.
All CUP consultants to meet to discuss pathways
8.
8.1
Patient Experience Feedback
The results from the National Cancer Patient Experience Survey 2014 have been
published but there were no individual results for CUP patients. At the last meeting
the group agreed they needed to develop a method of capturing patient feedback.
RSCH are in the process of devising a postal survey. The survey can potentially be
used for the other trusts.
9
Any Other Business/Dates of Future Meetings
CUP
consu
ltants
CUP Peer review – LS informed the group that the CUP service will be reviewed
next year and there will be an external visit between February and July.
There is a National Acute Oncology conference in Birmingham on 19th October
2015. Some members of the group are attending.
The date for the next meeting agreed.
Future Dates: Tuesday 8th December, 2.30pm- 4.30pm, Venue to be arranged.
17
ST. LUKE’S CANCER ALLIANCE
ALLIANCE AOS/CUP GROUP MEETING
Tuesday 8th December 2015
2:30pm – 4:30 pm
Room A6, PGEC, Royal Surrey County Hospital
Attended:
May Teoh (CHAIR) (MT)
Consultant Clinical Oncologist
ASPH/RSCH
Sian Wing (SW)
AOS CNS
ASPH
Faithe Cockroft (FC)
AOS CNS
ASPH
Nita Patel (NP)
Consultant Clinical Oncologist
FPH/RSCH
Jane Dickie (JD)
Cancer Quality Manager
RSCH
Aga Kehinde
AOS Nurse
RSCH
Martin Al Soof (MAS)
Locum
Consultant
in
Emergency
RSCH
Medicine/ED Lead for Oncology
David Griffin-Mead (DGM)
Team Leader
Physiotherapist
Eirini Thanopoulou
Consultant Medical Oncologist
SGH
Lisa Jacques (LJ)
AOS CNS
SASH
Lorraine Sime (LS)
Alliance Manager
SLCA
Jayshri Shetty (JS) part
Alliance Groups Manager
SLCA
Sue Couzens minutes (SC)
Alliance Groups Manager
RSCH
Apologies:
Andrew Davies (AD)
Consultant in Palliative Medicine
RSCH
Carol Redfern (CR)
Trust Head of Cancer Nursing and Patient
Support Services
RSCH
Helen Bennett (HB)
Cancer Services Manager
RSCH
John de Vos (JdV)
Consultant Haematologist
RSCH
Sam Russell (SR)
Acute Oncology CNS
RSCH
Sarah Watson (SW)
Consultant Radiologist
RSCH
Stephanie Wynter
Secretary to RSCH MOU & CUP team
RSCH
Oncology
-
Macmillan
RSCH
18
ST. LUKE’S CANCER ALLIANCE
George Erali (GE)
Locum Consultant Neurosurgeon
SGH
Pamela Floyd (PF)
Spinal Nurse Specialist/MSCC Coordinator
SGH
Joseph Peralta (JP)
AOS Nurse
FPH
Simon Gifford (SG)
Cancer Services Manager
FPH
Shobana Srinivasan (SS)
AOS Nurse
FPH
MINUTES
Action
1.
1.1
Welcome and Apologies
MT welcomed everyone to the meeting and apologies were listed for the minutes.
2
Minutes from the Previous Meeting on 23rd September 2015
The minutes were reviewed and agreed.
4.2 for action
3
4
Neutropenic Sepsis Audit presentation by all Trusts –
Neutropenic Sepsis Audits were presented by ASPH, RSCH and SASH (attached
with minutes. FPH were not able to present.
Neutropenic Sepsis audit discussion
ASPH – reported that increasing education of new nursing staff and reception staff
in A&E has had an impact on improving the door to needle times (last quarter JulySep 2015 percentage receiving antibiotics within 1 hour was 80%).
SaSH – also reported improvement (percentage receiving antibiotics within 1 hour
has risen from 26% to 36%). LJ reported that a trust wide Sepsis team meeting is
being held on the 13th November.
RSCH – also reported improvement from last year (percentage receiving antibiotics
within 1 hour has risen from 22% to 42%). Emphasis is placed on increasing
education of A&E nursing staff (recommended that this should occur at least once
every 4-6 months).There is difficulty with data collection (much of the data was
collected retrospectively, coding is often incorrect and not helpful). The updated NS
pathway is awaiting ratification by the Drugs and Therapeutics Committee at RSCH.
LJ and SW to review the audit tool.
5
MSCC
MT has discussed the updated pathway with the consultants at RSCH and all in
agreement to adhere to the pathway. MT circulated a (SINS) Spinal Instability
Neoplastic Score document to the group, which is a tool to objectively assess spine
stability. The group felt that as the tool had not been widely validated, it should not
be introduced as part of the pathway yet. MSCC Documents (Alert cards, Patient
information leaflets, Draft SOP) have been circulated for feedback and comment.
The final version for Alert Cards and Patient information leaflets is to be sent out
today – this should be printed at the individual trusts and given to appropriate
patients.
19
ST. LUKE’S CANCER ALLIANCE
6
6.1
6.2
7
CUP
CUP Peer review is taking place for the CUP MDT on 6th May. FPH will have a
separate visit. It was noted that it would be difficult to meet all measures, e.g. lack
of a Consultant Histopathologist, Palliative care cover
Pathways. All confirmed CUPs in the network who require systemic anticancer
therapy will be referred for treatment at RSCH under the care of MH and Dr Adrian
Franklin (SASH and ASPH patients will be treated by MH; RSCH and FPH patients
will be treated by Dr Franklin). It was confirmed that MUO’s should also be
discussed in the MDT (including those who are PS 3 or 4 who may not be suitable
for active treatment and further investigations).
There was a suggestion to review Dr Franklin’s job plan to see if there is availability
for him to review MUO/CUP patients locally at FPH instead of bringing patients to
RSCH for their diagnostic work-up – to be reviewed by local management at RSCH.
LJ stated that the MDT outcomes are difficult to use as Somerset is not linked to
SASH. There is an ongoing project to address the matter. Currently the outcomes
are being sent by email.
JD to review method of circulating MDT outcomes
The CUP audit topic was agreed (review histological subtype of CUP patients
discussed in the MDT). MH’s SpR will be collecting the data. The audit results will
be presented at the next NAOG meeting.
It is recognised that there is a lack of national clinical trials for CUP. All consultants
to review if it is possible to conduct local studies.
Patient Experience
There was discussion around how to best capture patient experience. A patient
questionnaire has been developed, which could potentially be sent to appropriate
patients by post.
JD
JD to circulate CUP questionnaire to the group for comments
8.
8.1
NAOG Meetings
Attendance – It was noted that attendance from other specialties (e.g. Acute
Medicine, Haematology) could be improved. MT suggested that meeting dates for
2016 are confirmed in advance and circulated to whole group. MT to send an email
to re-launch meetings and invite other specialties to attend.
9
Any Other Business
Future Dates: Tuesday 15th March, 2.30pm- 4.30pm, Oncology Seminar Room, level B, St
Luke’s, RSCH
Tuesday 7th June, 2.30pm- 4.30pm, Room B1, PGEC, RSCH
Tuesday 6th September, 2.30pm- 4.30pm, Room A4, PGEC, RSCH
Tuesday 6th December, 2.30pm- 4.30pm, Room B1, PGEC, RSCH
20
ST. LUKE’S CANCER ALLIANCE
ALLIANCE AOS/CUP GROUP MEETING
Tuesday 15th March 2016
2:30pm – 4:30 pm
Oncology Seminar Room, Royal Surrey County Hospital
Attended:
May Teoh (CHAIR) (MT)
Consultant Clinical Oncologist
ASPH/RSCH
Madeleine Hewish (MH)
Consultant Medical Oncologist
RSCH/ASPH
Adrian Franklin (AF)
Consultant Clinical Oncologist
FPH/RSCH
Carol Redfern (CR)
Trust Head of Cancer Nursing and Patient
RSCH
Support Services
Jane Dickie (JD)
Cancer Quality Manager
RSCH
John de Vos (JDV)
Consultant Haematologist
RSCH
Aga Kehinde (AK)
AOS Nurse
RSCH
Martin Al Soof (MAS)
Locum
Consultant
in
Emergency
RSCH
Medicine/ED Lead for Oncology
Peter Borlase (PB)
Cancer Services Manager
RSCH
Sam Russell (SR)
Acute Oncology CNS
RSCH
Stephanie Wynter (SW)
Secretary to RSCH MUO & CUP Team
RSCH
Thiagarajah Balamurugan
SpR Histopatholgy
RSCH
Eirini Thanopoulou (ET)
Consultant Medical Oncologist
SASH
Jane Penny (JP)
Lead Cancer Nurse
SASH
Katie Read (KR)
Review Radiographer
RSCH/SASH
Lisa Jacques (LJ)
AOS CNS
SASH
Rebecca Flint (RF)
Review Radiographer
RSCH/SASH
Lorraine Sime (LS)
Alliance Manager
SLCA
Sue Couzens minutes (SC)
Alliance Groups Manager
SLCA
21
ST. LUKE’S CANCER ALLIANCE
Apologies:
Bijal Pandya
Service Management Assistant
David Griffin-Mead
Team Leader
Physiotherapist
Joseph Peralta (JP)
AOS Nurse
Oncology
SGH
–
Macmillan
RSCH
FPH
MINUTES
Action
1.
1.1
Welcome and Apologies
MT welcomed everyone to the meeting and apologies were listed for the minutes.
2
Minutes from the Previous Meeting on 8th December 2015
The minutes were reviewed and agreed.
3
4
5
6
7
Update on MSCC
MT reported that she had recently attended the MSCC stakeholders meeting at
St Georges to review new proposed referral forms and pathways. More
information is required with regard to oncological history on the referral form.
Updated SLCA Network MSCC Pathways have been ratified and will be
circulated to the group.
MSCC and Neutropenic Sepsis Audit FPH presentation
The FPH MSCC audit was presented by May Teoh in the absence of Joseph
Peralta. There was no neutropenic sepsis audit presentation from FPH.
Update on Neutropenic Sepsis
LJ reported that new definition of SIRs criteria for sepsis is out. SASH Sepsis
group reviewing this in 2 weeks and further updates will be given at the next
meeting.
It was noted that not all trusts had included mortality in the last audit and that all
should present mortality.
LJ and SW have reviewed the neutropenic sepsis audit tool and minor changes
have been suggested. The group have discussed this and ratified the new audit
tool. This will be circulated to the group.
The next neutropenic sepsis audit (covering period from July – Dec 2015) will be
presented at the next NAOG meeting in June 2016.
AOB for AOS
None
Presentation of Network CUP audit
MH presented the CUP Network audit, which reviewed the histological diagnosis
of patients referred to the CUP MDT
The results showed that the presence of a histopathologist in the MDT to
participate in case discussions has significantly reduced the ‘True CUP’
diagnostic rate (from 34% in historical controls to 16% in the current audit). The
group acknowledged that the number of patients in this audit was small. Data
should continue to be collected and results re-audited in the future.
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ST. LUKE’S CANCER ALLIANCE
8
MUO/CUP referral pathways
Most patients come through the inpatient referral route and are seen by the
hospital AOS/CUP teams who advise on further investigations and management.
There was discussion around what happens to the patients when they are
discharged and still requiring further investigations. At RSCH, ASPH and FPH,
the AOS/CUP teams
take ownership and responsibility for monitoring the
patients progress and organising further investigations as appropriate. The
AOS/CUP CNSs are the patients’ keyworkers and provide ongoing support and
information for the patients. If a primary tumour site is found, patients are then
referred on to the site-specific oncology consultant and MDT. There is capacity
for patients to be seen in outpatients at RSCH and ASPH (by MH or MT). At FPH,
AF can see these patients on an ad-hoc basis in the ambulatory care unit. At
SASH, patients stay under care of discharging medical team and the AOS/CUP
team’s role is advisory. There is no capacity for these patients to be seen by the
AOS/CUP team as outpatients within 2 weeks. LJ still performs a keyworker role
and monitors the patients’ progress. She provides them her contact details and
provides ongoing support and information..
LJ reported there is a business case for a further nurse and 2 ½ sessions of
oncology and admin support.
The group discussed that the differences in pathways between the trusts should
be made clear in the constitution. All are aware of the current peer review
measures:
 All patients with suspected MUO/CUP should be referred to a member of
the hospital’s CUP assessment team, who is a core member of the CUP
MDT.
 Patients should be reviewed:
o Within 1 working day for inpatients
o Within 2 weeks for outpatients
 All suspected MUO/CUP patients should be discussed in the CUP MDT
 The designated AOS/CUP CNS should act as the patient’s keyworker
9
10
Patient experience
There was further discussion around how best to capture the patient experience.
The results of a local patient survey were circulated to the group for discussion.
Two main points from the survey were discussed:
 The results showed that patients did not always receive written
information. The CNSs reported that there are now CUP information
leaflets which are given to patients.
 The results showed that patients did not know who their clinical nurse
specialist was. It was suggested that there might be confusion around the
terminology used i.e. keyworker vs clinical nurse specialist. JD confirmed
that the term clinical nurse specialist was used in the survey. The group
agreed that patients may need to be reminded several times of who their
clinical nurse specialist is.
Other methods of capturing patient feedback were discussed. e.g. conducting an
interview with a patient by a patient rep. It was also suggested that this should be
added to the work programme for MDT. The Southampton CUP patient survey
analysis had previously been circulated to the group. The group discussed the
main findings which correspond with the results of the local survey. The main
findings were importance of keyworker/clinical nurse specialist role,
communication between teams and importance of ‘ownership’ of the patient.
Peer review
Peer review is on 6th May this year. Documents have to be uploaded by 6th April.
The changes in the constitution (reflecting above discussion in Point 8) were
23
ST. LUKE’S CANCER ALLIANCE
discussed. Final constitution will be circulated to group for final comments by 18th
March.
11
Any Other Business
Future Dates:
Tuesday 7th June, 2.30pm- 4.30pm, Room B1, PGEC, RSCH
Tuesday 6th September, 2.30pm- 4.30pm, Room A4, PGEC, RSCH
Tuesday 6th December, 2.30pm- 4.30pm, Room B1, PGEC, RSCH
24