London Cancer Upper GI (OG) Pathway Board

Transcription

1 Upper GI (OG) Pathway Board Date: Wednesday, 02 September 2015, 15:30 17:00 Venue: Meeting room 1, 3 rd Floor, 170 Tottenham Court Road, London, W1T 7HA Chair: Professor Muntzer Mughal, Pathway Director 1. Welcome and apologies (MM) MM welcomed members of the board and apologies were heard. Professor Naomi Fulop and Dr Angus Ramsay were welcomed to the Board as observers and to talk to item 8 on the. 2. Minutes of the last meeting (MM) The minutes of the last meeting were accepted as an accurate record of proceedings. 3. Review of action log and matters arising (MM) Barrett s surveillance lists LL is collating data and has agreed to share this. RP reported that PAH are currently in process of auditing but have not yet heard from LL with further information. ACTION: MM to discuss with LL and report back at next meeting Pan-London Awareness event DPH reported that they have received a positive response from George Hanna (GH) and Bob Mason (BM). There is a strong interest from other partners. Invitations will be sent by BM who has also provided the venue. MM raised the question of how we can sustain the momentum following a national campaign. BH reported that he attends many public awareness campaigns and hands out leaflet and felt that this method requires further resourcing as this method works due to personal contact which leads to more patients through GP practice doors. However patients are fearful of endoscopies or the thought of cancer being diagnosed. The Board agreed that the main difficulty lies in equipping GPs to make earlier diagnoses. Chemotherapy vs chemo radiation therapy trial still awaiting report from Daniel Hochhauser. ACTION: MM to follow up for next meeting. Dietetics a positive meeting with Kathy Pritchard-Jones was held. It was agreed that it would not be useful to write to trusts at this point. Instead, RS and KW would need to include the dietetic need in the service specification which RS was going to action and SC would raise this at the meeting planned to discuss commissioning intentions for 2016/17 on 03Sep. If agreed at this meeting, then commissioners would fund this element of work to ensure trusts are able to meet the specification. Dietetics and OSG this will be discussed under the main OSG item. 4. Review of treatment guidelines for squamous cell carcinoma of the oesophagus (MM) The current guidelines for treatment of squamous cell carcinoma of the oesophagus currently state that it can be treated by either definitive chemoradiotherapy or surgery. The form of treatment is be decided by the MDT advising the patient and the patient themselves. Surgery is offered for lesions longer than 10 cm as the radiation field would be extensive and 1

2 chemoradiotherapy for lesions of the upper third of the oesoiphagus. A trial in the Netherlands (The CROSS study) suggests that we should review our current guidelines. The two arms of thetrial were: i. Surgery only ii. Chemo radiation followed by surgery. The study showed improved survival in the patients having neoadjuvant chemoradiotherapy followed by surgery in patients with resectable oesophageal or oesophagogastric junctional cancer and that the improvement was particularly striking in patients with squamous cell cancer. MM reported that George Hanna (GH) has adopted the findings of the CROSS trial but this is not yet in the London Cancer Alliance (LCA) guidelines. MM has brought this issue to the Board today to ask if they are happy for GH and MM to write a summary paper to circulate to the Board as the data is persuasive for better outcomes for patients. This would then lead to discussions for pan- London guidelines. The Board agreed that a summary paper should be brought to the board. ACTION: MM to co-write summary paper to bring to Board for next meeting. 5. NICE guidance for suspected cancer: recognition and referral (MM) Circulated for information The Board noted that the previous guidance used a threshold of 5% to decide if a particular symptom was included as a trigger point. This has now been reduced to 3%. AM reported that he attended the workshop on 07July at which there was concern about the guidelines and how they would be implemented by GPs. He also reported that there was discussion regarding patients who may have suspected pancreatic cancer but go straight to endoscopy which would come back clear would that be the end of their pathway? RP reported that PAH have a catch all system to ensure patients are not pushed off the pathway i.e. if endoscopy is clear, they are asked to come back to an outpatient gastro clinic. The Board have accepted the guidelines and will review impact over the coming months. ACTION: PA to circulate link to revised 2WW forms on website POST MEETING MINUTE: Note that these forms were revised prior to the NICE guidance released on 23rd June We advise GPs to use these forms however, if you wish to refer a patient under the new NICE guidance referral criteria please do so and provide a clear clinical narrative and explanation for your referral within the free text area of the form. New pan-london two week wait suspected cancer referral forms are in development and there is a parallel workstream looking at direct-to-test and rapid access to diagnostics pathways in accordance with the new NICE guidance however this will take time to implement across London and we appreciate your patience. 6. Independent Cancer Strategy Task Force (MM) The message within this document differs from the NICE guidance, however it is easy to read and is much more focussed. The document talks about MDC clinics for patients with vague symptoms. AM reported that the clinics need to manned by consultants with several years experience. The clinics take complete charge of the pathway rather than bouncing the patient back and forth. Final results are sent back to the GP after all tests are exhausted. The MDC is also looking at including very unwell patients in ACE wave 2. 2

3 MM reported that CRUK and Macmillan will be piloting 60 sites where GPs will be given direct access to tests. They will also put a cancer nurse in large GP practices to speed up pathways. The reports also makes suggestions on how MDTs should work which will be discussed further at the London Cancer MDT Chair and Coordinator workshop on 08Sept. 7. OSG Update (MM) The work of the OSG is going well and they passed through gateway 4 with NHSE in July meaning that the centralisation of surgery has now been signed off. Go live date is December Barts Health surgeons will come to UCLH to operate. Queens will continue for the time being as specialist centre but will link in for a super specialist MDT with UCLH and BH. Outcomes from the super MDT will be fed back to the specialist MDTs. A further CNS is being recruited and an extra MDT coordinator will be appointed to track the pathway i.e. they will on a regular basis to find out what is happening and ensure the patient is on the correct part of their pathway. Generic issues like transport will be looked at across Head and Neck, Haem Onc and OG by UCLH. Dietetics was raised at OSG with the following outcome: i. The lack of dietetic service at BH for post-surgery the OSG stated that the purpose of the group was to address surgical and anaesthetist issues around the move of the cancer surgical service and that a lack of provision at a particular Trust will not be solved at the OSG rather it should be seen as an internal BH issue / overall network and possibly a national issue. Overall it was agreed that provision of dietetic support at any of the hospitals (local or centre or both) across all Trusts, as well as the pathways from local to centre, guidelines and standards sits best within the London Cancer remit as it involves all Trusts that act as local providers ii. AHP representation at OSG - the OSG is inclusive not exclusive but they want to make sure that the right discussions are within the right meetings. Frances Hughes was asked to contact Rashmi and Claire Levermore would speak to Katie. 8. NIHR RESPECT-21 (Prof Naomi Fulop) Professor Naomi Fulop (UCL Department of Applied Health Research) has been awarded 1.2 million over three and a half years by the National Institute for Health Research Health Services and Delivery Research Programme to study the centralisation of specialist cancer surgical services. The study commences in September and will focus on the impact of the centralisation of specialist surgical pathways for four cancers across two health care systems: London Cancer and Manchester Cancer. The research will combine quantitative and qualitative methods to analyse how the centralisations were planned and implemented, and the impact of the changes on organisation and delivery of care, clinical outcomes, patient experience, and costeffectiveness. The study will also analyse patient, professional, and public preferences for changes of this kind. In doing so, it will address a number of important gaps in the evidence on centralising specialist cancer surgery, addressing key priorities highlighted in the Five Year Forward View. In addition, it will build on methods developed by the team in conducting high impact research on other forms of major system change (document tabled: BMJ report) NF reported that she or senior members of her team are attending various meetings to observe the discussions taking place and how these feed into the bigger picture regionally / nationally. 3

4 MM reported that this study has come at the right time as London Cancer would have collected data and statistics but it would not have been independent. NF hopes that people will be receptive to requests for interviews. 9. Dates for 2016 Circulated dates were agreed with timings of 3:30-5:00PM on varying days. Schedule of dates below. 10. Next Meeting(s) Thurs 26-Nov-2015 Mon 18-Jan-2016 Tues 12-Apr-2016 Wed 13-Jul-2016 Thurs 10-Nov :30-17:00 Upper GI (OG) Pathway Board Meeting Room 1, 3rd floor, 170 Tottenham Court Road W1T 7HA 4

5 ACTION LOG Action Owner Date Agreed Status MM to contact Trusts who were asked to report on Dietetic Screening and query why they did not provide a return and point out potential area of risk. KW to circulate Dietetic data once complete for all to see. MM to confirm who in Trust this data should go to. Collate data and agreed guidelines and circulate to Trust management as evidence to prove/establish case for requirement of best provision of service/best Practice. Revise specification to set out a more stringent process of dietetics management, both short-term and long-term outcomes to be considered. MM to advise Trust senior management of potential risk in area of Dietetics, using collated data and the Guidelines to establish case for requirement of robust Dietetics service. KW will peer review audit data, and will amend guidelines as outlined and bring back to Board for approval. MM will write to Trusts regarding Best Practice as per the specification and outlining the data shortfalls in current Dietetic service along with benchmark data from GOSH. MM to write to ask for confirmation of Leads for Endoscopy lists and Barrett s Surveillance lists in Trusts. Work with LL to populate the registry locally within London Cancer. February meeting to have Early Diagnosis theme, MM to invite GH to present on Breathe test at the February meeting. DPH to contact GH and LL regarding possibility of doing pan- London Awareness event. 20/5/15 POST MEETING ACTION: DPH to take action forward and action log to reflect this KW, 13 Nov /5/15 main KW 13 Nov /5/15 main MM 13 Nov /5/15 & 02/09/2015: completed but needs to be chased MM to discuss with LL All, LL 13 Nov Sep 2015 MM 13 Nov 2014 Completed DPH 13 Nov 2014 Ongoing D Hochhauser to circulate report by David Cunningham re Chemotherapy versus Chemo-Radiation therapy trial DH/MM 10 Feb 2015 Delayed to 26 Nov 2015 as awaiting report from DH OSG update to be given at next meeting. MM 10 Feb 2015 Main Minor amendment to Minutes of previous meeting (KM) KM 10 Feb 2015 Completed Arrange a meeting with Kathy Pritchard-Jones (KPJ) / MM / DPH / KW and RS as soon as possible PA 20 May 2015 Completed Add lack of dieticians to Risk Register PA 20 May 2015 Completed Draft letter for KPJ and MM to send to trusts CEOs, MDs and NDs re lack of dieticians RS 20 May 2015 Completed no letter / discussed with commissioners 5

6 Action Owner Date Agreed Status OSG: Raise resource of dietetics at next OSG along with AHP representation at OSG MM 20 May 2015 Completed OSG: look at AHP rota for attending OSG going forward KW/RS 20 May 2015 Completed OSG: Draft and send to Pathway Board re outcome of dietetic discussions Squamous CC: draft summary paper with G Hanna to bring to Pathway Board MM 20 May 2015 Completed MM 02 Sept WW: circulated revised forms PA 02 Sept 2015 Completed 6

7 Attendees Muntzer Mughal, Pathway Director Andrew Millar Rosemary Phillips Brian Hill David Holden Pinki Amin - minutes Naomi Fulop Angus Ramsay University College London Hospitals NMUH Princess Alexandra Hospital Patient Representative Patient Representative London Cancer UCL UCL Apologies David Khoo Angela Wong Frances Hughes Katie Walker Donna Hodge Rashmi Soni Sharon Cavanagh Elizabeth Crisp Barking, Havering and Redbridge University Hospitals Barts Health Barts Health Royal Free London - Hampstead Royal Free London - Barnet and Chase Farm Barts Health London Cancer Patient Representative No apologies Clive Onnie Daniel Hochhauser George Hanna Jonathan Gardner Marc Winslet Martina Kelly Sherif Raouf Hassan Al-Ashimi Whittington Health University College London Imperial UCLH Royal Free London - Hampstead Homerton University Hospital Barking, Havering and Redbridge University Hospitals GP 7