Operational Policy. Bristol Supra-Regional Testicular Cancer MDT

Transcription

1 Operational Policy Bristol Supra-Regional Testicular Cancer MDT University Hospitals Bristol NHS Foundation Trust Minicom

2 Agreement to Operational Policy and Adoption of NSSG Guidelines Lead Clinician for Cancer Services Date Paul Barham Signature Lead Clinician of Bristol Supra-Regional Testicular Cancer MDT (on behalf of all MDT members and roles) Date Jeremy Braybrooke Signature Lead Clinician of Urology NSSG Date Raj Persad Signature Review Date Operational Policy Review Date: 15/05/2011 Versions Version Date Reason Sign Off /05/2009 Review and agreement by the Lead Clinician /07/2010 Version for 2010 Cancer measures Review 2 Operational Policy Bristol Supra-Regional Testicular Cancer MDT

3 1 Measure Checklist Measure Number Measure Operational Policy 08-2G-301 Single named lead clinician p G-302 Named core team members p11 Annual Report 08-2G-303 Team attendance at NSSG p G G G G-307 All consultants core member of at least one testicular MDT MDT meet at agreed frequency and record core attendance MDT agreed cover arrangements for core members Core member (or cover) present for 2/3 of meetings p11 p15 p11 p13 Work Plan 08-2G-308 Annual meeting to discuss operational policy p22 p15 p G G-310 Policy for all new patients to be reviewed by MDT MDT meeting with referring teams/collaborative audit 08-2G-311 Policy for communication of diagnosis to GP p18 p19 p G-312 Operational policy for named key worker p G G-314 MDT/network/supranetwork agreed testicular cancer follow up Operations to resect residual mass post chemotherapy 08-2G-315 Patients offered sperm storage p9 08-2G-316 Provision of written patient information/sperm storage p20 p9 p G-317 Core nurse member completed specialist study p G G G-320 Agreed responsibilities for core nurse member(s) Agreed list of additional responsibilities for one core nurse member Attendance at national advanced communications skills training programme p14 p G-321 Extended membership of MDT p G-322 Patient permanent consultation record p G-323 Patient experience exercise p21 p20 p8 08-2G-324 Presentation and discussion of patient experience exercise 08-2G-325 Provision of written patient information p18 p13 p16 p20 p10 p7 Operational Policy - Bristol Supra-Regional Testicular Cancer MDT 3

4 Measure Number 08-2G G G G G G G-332 Measure Agree and record individual patient treatment plans MDT/network/supranetwork agreed referral guidelines for testicular cancer MDT/network/supranetwork agreed referral guidelines to another team MDT/network/supranetwork agreed referral guidelines MDT discussion MDT/network/supranetwork agreed referral guidelines specialist care MDT/network/supranetwork agreed referral guidelines for testicular cancer referral of histology and radiology MDT/network/supranetwork agreed collection of minimum dataset Operational Policy p16 p47 p47 p47 p47 p47 p G-333 Electronic collection of MDS p G G-335 MDT/NSSG agreed participation in network audit MDT present results from participation in audit to NSSG Annual Report 08-2G-336 MDT/NSSG agreed list of approved trials p G-337 MDT/NSSG remedial actions from MDT's recruitment results 08-2G-338 Number of annual testicular cancer referrals p G-339 Total annual number of post chemotherapy surgical resections by individual surgeon p19 p21 p11 Work Plan p9 4 Operational Policy Bristol Supra-Regional Testicular Cancer MDT

5 2 Contents 1 Measure Checklist Contents Introduction Background Aims of the Operational Policy Testicular Services Bristol Testicular Cancer Clinic Sperm Storage The Role and Purpose of the Bristol Testicular Cancer Service MDT Multidisciplinary Team MDT Membership and Responsibilities Core Team Members Bristol Testicular Cancer Service Extended Team Members Lead Clinician Chair of the MDT Meeting Clinical Nurse Specialist The MDT Co-ordinator The MDT Meeting Organisation Referral to MDT from other Hospitals Treatment decisions at MDT Communication with Patients, Referring Teams and General Practitioners The Key Worker Clinical Guidelines Research and Audit Annual MDT meetings...22 Appendix 1Example of MDT Discussion List and MDT Outcome Form Example MDT Outcome Summary Example MDT Treatment Plan...27 Appendix 2Example of Key Worker Sticker...29 Appendix 3Patient Information...30 Appendix 4Example of BAUS Data Set...31 Appendix 5ASWCS Network Wide Minimum Dataset (MDS) Collection Policy Urological Cancer...33 Appendix 6ASWCS Guidelines for the Management of Testicular Cancer Introduction Supranetwork Multi-Disciplinary Team Working Network Site Specialist Group Meetings Initial Diagnosis and Referral Treatment Guidelines and Specialist Care Follow Up Policy [36]...57 Operational Policy - Bristol Supra-Regional Testicular Cancer MDT 5

6 6.7 References Testicular Cancer Flow Diagram Non Seminomatous Germ Cell Tumour (NSGCT) Flow Sheet Seminoma Flow chart Network Site Specialist Group Membership MDT Referral Form MDT referral Guidance Operational Policy Bristol Supra-Regional Testicular Cancer MDT

7 3 Introduction 3.1 Background This policy has been written to ensure that all members of staff are aware of the purpose, organisation and scope of the Avon Somerset and Wiltshire Cancer Services (ASWCS) Bristol Testicular Cancer Service (NTCS) Multidisciplinary team (MDT) at University Hospitals Bristol NHS Foundation Trust. This policy follows guidelines recommended by the National Manual of Cancer Services Standards, Avon Somerset and Wiltshire Cancer Services Network (ASWCS), the British Association of Urology Surgeons (BAUS) and NICE Improving Outcomes in Urological Cancers (2002). Please see Appendix 6 - ASWCS Guidelines for the Management of Testicular Cancer, Section Introduction on page 48 for more information. Operational Policy - Bristol Supra-Regional Testicular Cancer MDT 7

8 4 Aims of the Operational Policy The aim of the policy is to ensue that all members of the Bristol Testicular Cancer Service MDT at University Hospitals Bristol have agreed standards to promote best practice and provide high quality patient care in the management of men with Testicular Cancer and give Guidance to those caring for women with Germ Cell Cancers. The objectives of Multidisciplinary Team (MDT) are: To ensure that designated specialists work effectively together so that assessment and decisions regarding all aspects of the diagnosis, treatment and care of patients are based on multidisciplinary review. To ensure that care is given according to current research findings and recognised guidelines To ensure that appropriate information is being collected to inform clinical decision-making and to support clinical governance and audit. To ensure that all decisions regarding the MDT operational policy are decided and agreed by all members of the multidisciplinary team. To ensure that patients are offered entry into suitable clinical trials and that mechanisms are in place to support the entry of eligible patients into clinical trials subject to patients giving full informed consent. 8 Operational Policy Bristol Supra-Regional Testicular Cancer MDT

9 5 Testicular Services As the Supra network centre for male patients with germ cell tumours the University Hospitals Bristol NHS Foundation Trust (UHBristol) is equipped and staffed appropriately to provide the following, Dedicated Testicular Cancer Clinic Dedicated Urology outpatients department with access to testicular specialist and core team members Dedicated Urology and Oncology wards Germ Cell and Uro-oncology Clinical Nurse Specialists Dedicated Urology theatres Psychosexual counselling network Post Chemotherapy Retroperitoneal Surgery (RPLND) Access and information to Sperm Storage 5.1 Bristol Testicular Cancer Clinic The Bristol Testicular Cancer Clinic is held on a Friday morning at Bristol Haematology Oncology & Centre starting at 9.15am. The attending consultants are Dr Jeremy Braybrooke and Dr Susanna Alexander (locum from September 2009, prior to this Dr Robert Jones). The Clinical Nurse Specialist / Key worker will also be present at the clinic. New and follow up patients, as well as those on treatment are reviewed in the clinic. Specific recommendations for follow up are listed in Appendix 6 - ASWCS Guidelines for the Management of Testicular Cancer, section Follow Up Policy [36] on page 57. All new patients and patients on follow up with specific needs are seen by the Germ Cell Clinical Nurse Specialist. Normally a specialist registrar in medical and/or clinical oncology will attend. The clinic provides good educational opportunities for management of patients with germ cell tumours. 5.2 Sperm Storage Sperm Storage must be discussed with all patients prior to chemotherapy and radiotherapy. Referrals should be made to Bristol Centre for Reproductive Medicine according to the Standard Operating Procedure (SOP), UHBristol. The Sperm Storage SOP is a document controlled and as such cannot be attached as an appendix. Please see For queries contact Susie Heyworth, Clinical Nurse Counsellor For more information please refer to the ASWCS Guidelines for the Management of Testicular Cancer. Operational Policy - Bristol Supra-Regional Testicular Cancer MDT 9

10 6 The Role and Purpose of the Bristol Testicular Cancer Service MDT Multidisciplinary Team The Bristol Testicular Cancer Service MDT follows the Network Site Specific Group Clinical Guidelines. These guidelines will be reviewed at least annually to promote evidence based practice. The Bristol Testicular Cancer Service MDT will: Provide a rapid diagnosis and assessment service for patients with Testicular Cancer within the ASWCS Network Identify and manage the treatment of men with Testicular Cancer. Provide specialist advice and treatment plans for men with complex Testicular Cancer and those requiring Retro Peritoneal Lymph Node Dissection (RPLND) from Three Counties and Peninsula Networks. Act in an advisory role for the plan of care and treatment for females with Germ Cell Cancers. Act in an advisory role for the plan of care and treatment for paediatrics with Testicular Cancer. Be responsible for the provision of information, advice and support for men with testicular cancer and their carers, throughout the course of their illness. Provide all patients and carers with a point of contact (a named key worker) within the multidisciplinary team, for queries relating to an individual s management (in almost all cases the key worker will be the NTCS MDT core specialist nurse). Provide treatment and follow-up plans for every patient with a Testicular Cancer with the appropriate multidisciplinary input. Provide advice to the Gynaecological MDT of treatment and follow-up plans for every female patient with Germ Cell Cancer with the appropriate multidisciplinary input. Provide a rapid onward referral service for patients who require management by other clinical teams Ensure that all patients newly diagnosed with Testicular Cancer are offered a meeting with the oncologist and specialist nurse to discuss treatment options before deciding on the course of treatment. Ensure that GPs and referring centres are given prompt and full information about their patient s diagnosis and any changes in their patients illness or treatment. Participate in NSSG audit projects and present results to the NSSG. Implement service improvement to benefit the patient journey. This will include process mapping and action planning. One member of the MDT will be identified as the lead for service improvement activities. Provide a forum for training junior doctors and developing healthcare professionals. Inform medical and nursing students of the process and function of the MDT. Develop a portfolio of clinical trials and ensure that patients are considered for clinical trials in line with the Cancer Plan (2002) Ensure that protocols, guidelines and standard operating procedures are developed and kept updated for all aspects of management, diagnosis and treatment of patients with Testicular Cancer. 10 Operational Policy Bristol Supra-Regional Testicular Cancer MDT

11 7 MDT Membership and Responsibilities 7.1 Core Team Members Role Core Team Member Cover Lead Clinician for MDT Consultant Medical Oncologist Consultant Medical Oncologist Consultant Clinical Oncologist Consultant Urologist Consultant Radiologist Consultant Histopathologist Consultant Histopathologist Germ Cell Clinical Nurse Specialist Uro-Oncology CNS Jeremy Braybrooke Tel: (lead for clinical trials recruitment) Susanna Alexander Amit Bahl Tel: Tim Whittlestone Tel: Julian Kabala Tel: Chris Collins Tel: Mohammed Sohail Sue Brand Tel: or Mobile Julia Hardwick Tel: MDT Coordinator Toni-Marie Harvey Tel: Susanna Alexander Jeremy Braybrooke Serena Hilman Janice Ash-Miles Mohammed Sohail Chris Collins Tel: No Named cover but is able to attend 80% of meetings (lead for user involvement and information) No Named cover but is able to attend 80% of meetings Dan Brown Tel: Mr Tim Whittlestone is the surgeon responsible for resection of post chemotherapy residual masses. He is the Supranetwork surgeon and specialist and has no cover. Operational Policy - Bristol Supra-Regional Testicular Cancer MDT 11

12 7.2 Bristol Testicular Cancer Service Extended Team Members This table provides the names and contact details of the extended members of the Bristol Testicular Cancer Service Multi-Disciplinary Team Extended Team Members are not expected to routinely attend MDT meetings but should attend the AGM Role Name Contact Details Secretary Susan Gray Tel: Bristol Centre for Reproduction Medicine Specialist Nurse Counsellor Urology Specialist Practitioner (psychosexual counsellor) Susie Heyworth Tel: Wendy Hurn Tel: Clinical Psychologist James Brennan Tel: Palliative Care Consultant Rachel Mccoubrie Tel: Palliative Care Nurse Gaye Senior-Smith* Tel: Clinical Research Nurse Tristan Grey Tel: Clinical Trial Officer Lloyd Abood Tel: Clinical Trial Co-ordinator Rebecca Swinson Tel: Teenager and Young Adults (TYA) Lead Nurse Cancer Services Deidre McGuigan Tel: Mobile: Consultant Oncology Roger Owen Consultant Nurse Oncology Cheltenham Hospital Ian Ingledew Consultant Oncologist (Truro) Duncan Wheatley Consultant Oncology (Plymouth) Martin Highley Staff Nurse (Testicular Cancer Link Nurse Ward 61 BHOC) Staff Nurse (Testicular Cancer Link Nurse OPD BHOC) Senior Staff Nurse (Testicular Cancer Link Nurse CDU BHOC) Stuart Milton Tel: Janet Smith Tel: Susie Budd Tel: Clinic coordinator Manager Tracy Zehtabi Tel: Operational Policy Bristol Supra-Regional Testicular Cancer MDT

13 *Note: When a Palliative Care Referral is required it is made to Palliative Care Team by the Germ Cell CNS or medical staff, and will attend to discuss specific patients at the request of a team member. This table provides the names and contact details of Urology Nurses from referring Centres in the Network Name Status Contact Details Sharon Tonkin Miranda Benney Rosalie May Peter Gill Weston General Hospital Weston Super Mare Royal United Hospital Bath Royal United Hospital Bath Southmead Hospital Bristol Debi Cole Yeovil District Hospital Karen Moffett Yeovil District Hospital Wendy Endicott Julia Pollard 7.3 Lead Clinician Musgrove Park Hospital Taunton Musgrove Park Hospital Taunton Jeremy Braybrooke, Consultant Medical Oncologist is the lead clinician for the Bristol Testicular Cancer Service MDT. The responsibilities of the Lead Clinician are: To ensure that the objectives of the MDT working (as laid out in the Manual of Cancer Services Standard) are met. o to ensure that designated specialists work effectively together in teams such that decisions regarding all aspects of diagnosis, treatment and care of individual patients and decisions regarding the team s operational policies are multidisciplinary decisions; o to ensure that care is given according to recognised guidelines (including guidelines for onward referrals) with appropriate information being collected to inform clinical decision making and to support clinical governance/audit; o to ensure mechanisms are in place to support entry of eligible patients into clinical trials, subject to patients giving fully informed consent; overall responsibility for ensuring that MDT meeting and team meet peer review quality measures; ensure attendance levels of core members are maintained, in line with quality measures; ensure that target of 100% of cancer patients discussed at the MDT is met; provide link to NSSG either by attendance at meetings or by nominating another MDT member to attend; lead on or nominate lead for service improvement; organise and chair annual meeting examining functioning of team and reviewing operational policies and collate any activities that are required to ensure optimal functioning of the team (e.g. training for team members); ensure MDT s activities are audited and results documented; ensure that the outcomes of the meeting are clearly recorded and clinically validated and that appropriate data collection is supported; Operational Policy - Bristol Supra-Regional Testicular Cancer MDT 13

14 ensure target of communicating MDT outcomes to primary care is met. 7.4 Chair of the MDT Meeting A designated member of the MDT will chair the meeting. The responsibility of the MDT chair is to ensure: The meeting runs to time. Each patient discussed has a clear treatment plan. Lines of responsibility are clear for carrying out any action plan, including contacting the patients, arranging further tests or contacting another healthcare professional. That decisions are recorded on the Bristol Cancer Register (BCR) during the meeting, with all team members in agreement of the final decision. Development of the MDT and its activities. Training needs of the team are identified and met including junior doctors and medical students. 7.5 Clinical Nurse Specialist Sue Brand, Germ Cell Clinical Nurse Specialist is the core nurse member of the NTCS MDT. The NTCS MDT core specialist nurse has the following responsibilities within the MDT: Work with the MDT to promote a planned, effective holistic approach to the care and management of patients with testicular cancer. Work with the MDT and the Gynaecological MDT to promote a planned, effective holistic approach to the care and management of female patients with Germ Cell Cancer. To be a resource for the Paediatric Team to promote a planned, effective holistic approach to the care and management of paediatrics with Testicular Cancer. Work with the Key Workers for Three Counties Network and Peninsula to ensure careful planning for the transfer of care to the MDT. Contribute to the multidisciplinary discussion and patient assessment/care planning decisions of the team at their regular meetings. Provide expert nursing advice and support to other healthcare professional in this specific area of practice. Involvement in clinical audit and research, and utilising research both medical and nursing in this specific area of practice. Leading on patients and carer s communication issues and coordination of the patient s pathway. Contributing to the management and service improvement of the service. Acting as the key worker or in cases where this is not appropriate, responsible for nominating the key worker for the patient s care and management. For patients requiring Retroperitoneal Lymph Node Dissection the Key Worker responsibilities will temporarily transfer to the UHBristol Urology CNS and return to the Germ Cell CNS post procedure. The Germ Cell Clinical Nurse Specialist and the Urology CNS will be responsible to hand over appropriate information regarding care. To ensure an annual review of patient information provided and ensure that patient information is in line with National Strategies. Lead on patient information. Provide a range of information and resources for patients. Contributing to the management of the service. Involvement in clinical audit Participation in research. 14 Operational Policy Bristol Supra-Regional Testicular Cancer MDT

15 Communication with the extended members of the MDT to provide timely and appropriate referrals for patients to palliative care services, dietetics and clinical trials. Contribute to the patient support group Sue Brand has certification for BSc in Cancer Care and a Diploma in Oncology, and is on the waiting list for the advanced communication skills training course. Julia Hardwick is the Uro-oncology Clinical Nurse Specialist for RPLND patients. Julia has certification for MSc in Cancer Care, BSc Health Studies and has completed the advanced communication skills training course. 7.6 The MDT Co-ordinator The NTCS MDT Coordinator is Toni-Marie Harvey, telephone number , fax Her working hours are as below Tuesday 8am - 2pm Thursday 8am - 2pm Friday 8am - 12pm The agreed cover is Dan Brown, telephone number , fax: (Monday to Friday). The MDT coordinator provides the following support to the MDT team. Liaising with consultants, nursing staff, secretaries, other MDT coordinators, histopathology and radiology within ASWCS network in preparing for the MDT. Coordinating information from outside of the ASWCS Network, primarily from 3 Counties and Peninsula Networks. Ensuring the relevant patients notes are obtained and present at the MDT meetings. Maintaining the attendance record for every meeting. (It is the responsibility of the individual MDT members to sign the attendance record each week). Ensuring that any patients on the MDT list who is not discussed because of lack of time of inadequate information will automatically be added to the following meeting s list. To record the outcomes of the meeting and ensure the information is filed in the patient s notes and kept on the electronic database. Collates / validate the dataset for new cancers and waiting times The Cancer Register will be used live in the MDT to capture the MDT outcomes and decisions and as a minimum the following information will be recorded: (see Appendix 1 - Example of MDT Discussion List and MDT Outcome Form on page 23 for example of MDT discussion list and outcome record). o The identity of patients discussed o The diagnosis, at the time of making the treatment / referral decision including type of cancer. 7.7 The MDT Meeting Organisation All patients will be referred to the MDT using the ASWCS Bristol Testicular Cancer Service Referral Form (see Appendix 6, section MDT Referral Form on page 68) and ASWCS Bristol Testicular Cancer Services referral guidelines (see Appendix 6, section MDT referral Guidance on page 69). All patients with a new diagnosis of a Testicular Cancer in the ASWCS Network are to be reviewed and the treatment decisions documented at the MDT at the earliest opportunity. All patients with a new diagnosis of a female Germ Cell Cancer in the ASWCS are to be reviewed and advice of treatment decisions will be documented at the MDT at the earliest opportunity. Operational Policy - Bristol Supra-Regional Testicular Cancer MDT 15

16 Patients referred for specialist treatment decisions from the Bristol Children s Hospital, Three Counties and Peninsula Network are to be reviewed and documented at the MDT at the earliest opportunity. The MDT will also be used to discuss the management of complex testicular cancer/germ cell cancer cases subsequent to diagnosis if necessary. Where referrals need an urgent management decision before the MDT meeting takes place decisions on the patients care can be made by a senior member of the team and the case discussed at the next scheduled meeting. MDT meetings will be held on Friday at am in the left hand side conference room, level 3 Bristol Royal Infirmary. Each core member of the team should arrange cover for their absence. Core members or their arranged cover will attend at least two thirds of the arranged meetings; Attendance records will be kept by the MDT coordinator to facilitate the audit of this requirement. MDT operational policy review meetings will be scheduled at least annually. All core team members (or their nominated deputies) are expected to attend. This meeting will assess, plan, implement and evaluate operational changes and strategy. Any operational issues requiring discussion in between these meetings may be dealt with during the weekly MDT meetings and the agreed outcomes will be recorded in the MDT minutes. Any meetings which need to be cancelled must be highlighted to the MDT coordinator who will ensure all members of the MDT are aware of the cancellation. The number of meeting cancelled will be monitored at the MDT operational policy meetings. The outcomes of the discussions for each patient will be recorded on the MDT form which will be filed in the relevant patient s notes. Electronic copy of the MDT outcomes will also be kept by the MDT coordinator on the Bristol Cancer Register The MDT will collect the relevant data to comply with NSSG minimum dataset (see Appendix 5 - ASWCS Network Wide Minimum Dataset (MDS) Collection Policy Urological Cancer on page 33) 7.8 Referral to MDT from other Hospitals For full referral details please refer to the ASWCS Guidelines for the Management of Testicular Cancer, for a summary of the Bristol Testicular Cancer Service. Also all patients will be referred to the MDT using the o ASWCS Bristol Testicular Cancer Service Referral Form (see Appendix 6, section MDT Referral Form on page 68) o ASWCS Bristol Testicular Cancer Services referral guidelines (see Appendix 6, section MDT referral Guidance on page 69) Copies of any patient clinic letters, blood results, histology slides, radiological reports should be sent to the MDT co-ordinator. Where every possible the sending of CDs should be avoided and PACS used to view images. Patients must be discussed at the next available MDT meeting, following receipt of the referral information. 7.9 Treatment decisions at MDT Treatment decisions are recorded electronically at the MDT meeting. Each treatment decision is agreed at the meeting and recorded on the Cancer Register. A hard copy of this is then printed out and kept as a permanent record within the patient case records. When a final treatment decision cannot be made, appropriate treatment alternatives are outlined by the MDT. The responsible clinician then shares treatment alternatives with the patients and a final treatment decision is reached. If treatment decisions change from suggested MDT treatments after the meeting, they are reported back at the next available MDT. Follow-up communication for patients and their GP may vary. It includes 16 Operational Policy Bristol Supra-Regional Testicular Cancer MDT

17 o Outpatient clinic or next available clinic appointment o Local hospital outpatient appointment o Telephone conversation with the patient by the CNS or Consultant o Secure or fax MDT letter to GP Operational Policy - Bristol Supra-Regional Testicular Cancer MDT 17

18 8 Communication with Patients, Referring Teams and General Practitioners For patients newly diagnosed with Testicular Cancer, the GP will be informed within 24 hours of the patients receiving the diagnosis by the Urology Teams local process. An outline for the management / treatment plan will also be included. This information will be faxed using the urgent GP notification form. Should discussion at the MDT or with the patients lead to alterations in the treatment plan the GP will be informed at the earliest possible time. Audit to monitor the timeliness of informed GPs notification of a patient s diagnosis will be carried out in accordance with National Guidelines and the Urology MDT Operational Policy. Patients will be offered the opportunity for a permanent record or summary of a consultation at which their diagnosis and their treatment options were discussed. Details of which are provided via NTCS. There should be a printout of the Bristol Cancer Registry new patient record o The offer of a Key worker and if accepted or declined. o Given the key workers contact details and accepted. o MDT information for patient s and carers. o Summary of written patient information given. Patients will be offered information regarding local and or national support groups where these exist. Patients should be offered written information of their cancer and their treatment options. For full details of patient information provided please refer to Appendix 6 - ASWCS Guidelines for the Management of Testicular Cancer on page 47, for a summary of the Bristol Testicular Cancer Service. 18 Operational Policy Bristol Supra-Regional Testicular Cancer MDT

19 9 The Key Worker The Key Worker, with the patients consent and agreement, takes a crucial role in coordinating treatment plan and continuing care The MDT core specialist nurse will be responsible for identifying a single named key worker for the patient s cancer care. It is anticipated that in almost all cases the key worker will be the MDT core specialist nurse. The identification of the key worker will be made when the diagnosis of a Testicular Cancer is communicated to the patient. If the patient s diagnosis of malignancy is not first confirmed in the MDT meeting, it is the responsibility of the patient s consultant to advise the specialist nurse of the diagnosis at the first opportunity. In the event of an emergency inpatient admission where a Testicular Malignancy is subsequently diagnosed, it is the responsibility of the patient s consultant team to refer the patients to the MDT core specialist nurse. The referring clinician must in every case advise the specialist nurse of the information the patients and/or (as appropriate) next of kin has already been given about his confirmed or anticipated diagnosis of malignancy. Patients will be given contact details for their key worker at the earliest opportunity, preferably at diagnosis/orchidectomy. Once the key worker has been allocated the key worker s name will be clearly recorded in the patient s case notes and on the Bristol Cancer Registry. Operational Policy - Bristol Supra-Regional Testicular Cancer MDT 19

20 10 Clinical Guidelines The MDT have written and adhere to the Avon Somerset and Wiltshire Cancer Network Site Specific Group Clinical Guidelines for the management of Testicular cancer. The guidelines are reviewed regularly by the NSSG and amendments discussed within the local MDT. For full details please refer to Appendix 6 - ASWCS Guidelines for the Management of Testicular Cancer on page 47 for a full copy of the NSSG guidelines. 20 Operational Policy Bristol Supra-Regional Testicular Cancer MDT

21 11 Research and Audit Research and audit leading to evidence based practice should form the core working philosophy for the whole team. All professions should be encouraged to share their findings Patients should be regularly involved in surveys and user groups. Their views should be sought on all aspects of the Testicular Cancer service, including service design, patient information leaflets and feedback of service received. Information from patient surveys will be discussed by the MDT, an action plan formulated and reviewed to ensure that any relevant actions have been implemented. A Network Audit programme is to be agreed. The MDT will actively take this forward. Patients should be offered the opportunity to participate in clinical trials and other well designed studies when ever the appropriate study is available. A list of clinical trials and research studies the MDT is currently participating in will be circulated quarterly to the Network, NSSG, and all parties referring patients to the NTCS. The MDT will nominate one of the members of the team, normally the Clinical Trial Unit representative, as the person responsible for ensuring that recruitment to clinical trials and research studies is integrated into the function of the MDT. The MDT should produce a written response annually to the NSSG s approved list of clinical trials and other well designed studies. The MDT Clinical Coordinator and Cancer Manager will arrange for an audit to monitor the number of two week wait referrals, the number of these patients subsequently found to have Testicular Cancer and the number of routine referral found to have Testicular Cancer. These results will be discussed at the MDT AGM and disseminated to the PCTs. The MDT will utilise the Cancer Register for the collection of all information in relation to Testicular / Germ Cell oncology and the number of RPLNDs performed annually. The register contains the required fields of the BAUS dataset in addition to the National Cancer Waiting Times and as such the team are to electronically collect the network agreed minimum dataset, see Appendix 5 - ASWCS Network Wide Minimum Dataset (MDS) Collection Policy Urological Cancer on page 33 Research and Audit leading to evidence should be the basis of the practice of the whole team. All professions should be encouraged to share the findings at the MDT AGM and disseminated to the PCTs. The core Histopathology member of the MDT will take part in an EQA scheme as guided by the pathology department within Trust, documentation of involvement will be provided by the Pathology Services Manager. Operational Policy - Bristol Supra-Regional Testicular Cancer MDT 21

22 12 Annual MDT meetings MDT Operational Policy review meetings are scheduled annually. Any operational issues requiring discussion in the interim may be dealt with during the weekly MDT meeting and agreed outcomes recorded in the MDT minutes. 22 Operational Policy Bristol Supra-Regional Testicular Cancer MDT

23 Appendix 1 Example of MDT Discussion List and MDT Outcome Form 1.1 Example MDT Outcome Summary Outcome of Testicular MDT list for 27/02/2009 NHS Number: Hospital Number: Consultant: Date of Birth: Name: Diagnosis Date: 30/01/2009 Diagnosis: C621 - Malignant neoplasm of descended testis First Treatment: Referred to: MDT Comments: Active Monitoring Dr Braybrooke for Oncology Histology showed Embryonal carcinoma with a foci of yolk sac. No Vascular invasion. Confined to testes. PT1. CT Report suggested normal. Plan - CT scan needs formal review at MDT. Recommend Surveillance. Clinical Trial Status: NHS Number: Hospital Number: Consultant: Date of Birth: Name: Diagnosis Date: 25/08/2008 Diagnosis: C621 - Malignant neoplasm of descended testis First Treatment: Referred to: MDT Comments: Chemotherapy Dr Braybrooke for Oncology Histology showed a mixed germ cell with 90% Teratoma & the occasional foci of Embryonal carcinoma. Possible yolk sac component. CT Scan showed The Para Aortic Lymphadenopathy remains unchanged from the previous scan at 32mm. Plan - patient to complete 4 cycles of Chemotherapy then Re-scan and refer to THW for Surgery if required. Clinical Trial Status: NHS Number: Hospital Number: Consultant: Date of Birth: Name: Diagnosis Date: Diagnosis: Operational Policy - Bristol Supra-Regional Testicular Cancer MDT 23

24 MDT Comments: USS Aug 07 showed a slight abnormality. USS 19/01/09 showed an abnormality within the testicular tissue this is not aggressive at present. There is the possibility of cancer. Plan - JPB to write to NBT. Patient needs to be told and given the choice of Surgery or Surveillance. Clinical Trial Status: NHS Number: Hospital Number: Consultant: Date of Birth: Name: Diagnosis Date: 08/06/2007 Diagnosis: C62 - Malignant neoplasm of testis MDT Comments: Recycle for MDT 06/03/09. Clinical Trial Status: NHS Number: Consultant: Gillatt Hospital Number: Date of Birth: Name: Diagnosis Date: 28/07/2008 Diagnosis: C62 - Malignant neoplasm of testis First Treatment: Referred to: MDT Comments: Active Monitoring Dr Braybrooke for Oncology CT Scan showed a good response. Patient has an OPA 17/04/09 check markers on arrival. Clinical Trial Status: NHS Number: Consultant: Braybrooke Hospital Number: Date of Birth: Name: Diagnosis Date: 22/04/2008 Diagnosis: C62 - Malignant neoplasm of testis First Treatment: Referred to: MDT Comments: Active Monitoring Dr Braybrooke for Oncology Continued reduction in size of the residual mediastinal mass. Plan - For a Re-scan in 6 months. OPA 06/03/09. Sue to call patient. Clinical Trial Status: 24 Operational Policy Bristol Supra-Regional Testicular Cancer MDT

25 NHS Number: Consultant: Whittlestone Hospital Number: Date of Birth: Name: Diagnosis Date: Diagnosis: MDT Comments: Recycle for MDT 06/03/09 Clinical Trial Status: NHS Number: Hospital Number: Consultant: Date of Birth: Name: Diagnosis Date: 02/02/1992 Diagnosis: C62 - Malignant neoplasm of testis First Treatment: Referred to: MDT Comments: Chemotherapy Dr Braybrooke for Oncology CT Scan showed a partial response. Plan - Patient to continue with Chemotherapy. If markers normalize for Re-Scan then discuss Surgery. Clinical Trial Status: NHS Number: Hospital Number: Consultant: Date of Birth: Name: Diagnosis Date: 01/02/2009 Diagnosis: C621 - Malignant neoplasm of descended testis MDT Comments: Recycle for MDT 06/03/09 Clinical Trial Status: NHS Number: Hospital Number: Consultant: Date of Birth: Name: Diagnosis Date: 29/01/2009 Diagnosis: C621 - Malignant neoplasm of descended testis Operational Policy - Bristol Supra-Regional Testicular Cancer MDT 25

26 First Treatment: Referred to: MDT Comments: Chemotherapy Brewster for Oncology CT scan showed no Lymphadenopathy and normal adrenals. Patient was seen 20/02/09 and is to start chemotherapy. Clinical Trial Status: NHS Number: Hospital Number: Consultant: Date of Birth: Name: Diagnosis Date: 21/01/2009 Diagnosis: C621 - Malignant neoplasm of descended testis First Treatment: Chemotherapy Second Treatment: Active Monitoring Referred to: MDT Comments: Dr Braybrooke for Oncology Histology showed classical Seminoma with no vascular invasion. Confined to testes. PT1. Biopsy of the right was normal. CT Scan showed no Lymphadenopathy but post inflammatory changes in the chest. Patient has an OPA 27/02/09 will discuss Surveillance Vs Chemotherapy. Clinical Trial Status: NHS Number: Hospital Number: Consultant: Date of Birth: Name: Diagnosis Date: 19/09/2008 Diagnosis: C62 - Malignant neoplasm of testis MDT Comments: CT scan could not be viewed due to technical problems. Patient is being seen 27/02/09 to assess fitness. Sue to convey Clinic outcome to Martin. Clinical Trial Status: NHS Number: Hospital Number: Consultant: Date of Birth: Name: Diagnosis Date: 01/12/2007 Diagnosis: C621 - Malignant neoplasm of descended testis First Treatment: Active Monitoring 26 Operational Policy Bristol Supra-Regional Testicular Cancer MDT

27 Referred to: MDT Comments: Dr Braybrooke for Oncology CT Scan showed stable disease. Plan - For a Re-scan in 6 months. Clinical Trial Status: PLEASE DO NOT PUT A COPY OF THIS IN THE PATIENTS NOTE 1.2 Example MDT Treatment Plan Pre-Treatment Multidisciplinary Urology/ Testicular () Cancer Meeting Date of Meeting:25/07/2008 This management plan relates to the original primary cancer NHS Number: Hospital Number: Consultant: Mr Persad Surname: Forename: Date Decision to Refer: 11/09/2007 Date of Birth: Date of First Appt: 21/09/2007 Priority: 2ww Referral Address: GP Name: DR GP Address: Presentation Investigation Date Investigation Performed Type Site Outcome Comments 21/09/2007 Ultrasound Testis Abnormal 10/10/2007 CT Scan 05/02/2008 CT Scan Chest Abdomen To Be Performed Pelvis Chest Abdomen To Be Performed Pelvis 01/07/2008 CT Scan - Abnormal Diagnosis Date of Diagnosis: 21/09/2007 Diagnosis: Malignant neoplasm of testis (Left) Liver Mets: None Bone Mets: None Lung Mets: None Brain Mets: None Other Mets: None Operational Policy - Bristol Supra-Regional Testicular Cancer MDT 27

28 Date of Surgery: 04/10/2007 Main Procedure: Orchidectomy Treatment Intent: Curative Treatment Pathology MDT Decision / Care Plan Care Plan Agreed at MDT:Yes Referred to: Dr Braybrooke for Oncology MDT Comments: Patient needs a PET Scan. 28 Operational Policy Bristol Supra-Regional Testicular Cancer MDT

29 Appendix 2 Example of Key Worker Sticker Cancer Nurse Specialist / Key Worker Cancer Site / Speciality Date of first contact with CNS/Key Worker Written Information Offered Yes / No Accepted / Declined Patient offered copy of treatment plan/letter As permanent record of consultation Yes / No Accepted / Declined Notes: Operational Policy - Bristol Supra-Regional Testicular Cancer MDT 29

30 Appendix 3 Patient Information Information for Men Diagnosed with Testicular Cancer -University Hospital Bristol NHS Foundation RPLND information leaflet Cancer Treatment and Fertility Information For Men Cancer Backup Sperm Freezing for Cancer Patients Bristol Centre for Reproductive Medicine Macmillan Testicular Cancer Also there is now a dedicated website 30 Operational Policy Bristol Supra-Regional Testicular Cancer MDT

31 Appendix 4 Example of BAUS Data Set NHS Number: Hospital Number: Name: DoB:00/00/00 Q1. Consultant: Q2. Hospital Number: Q3. NHS Number: Q4. Postcode: Q5. Sex: Male Q6. Date of Birth: Q7. Date Decision to Refer: 15/03/2008 Q8. Source of Referral: General Medical Practitioner Q9. Priority of Initial Referral: Two Week Wait Q10. Date of First Appt: 20/03/2008 Referral Diagnosis Q11. Date of Diagnosis: 20/03/2008 Q12. Delay to Diagnosis: None Q13. Basis of Diagnosis: Radiology Q14. Diagnosis: C62 - Malignant neoplasm of testis Q15. Laterality: Right Q16. Histology: Q17. Report Number: Q18. Differentiation: Staging Q19. Clinical Staging: T N M Q19. PSA at Diagnosis: (Prostate only) Q19. Gleason Score: + (Prostate only) Q19. S Category: (Testis only) Treatment Q20. First Treatment Intent: Curative Q21. First Treatment: Surgery: Endoscopic Resection No Endoscopic Resection + 1 No Radical Shot Intra-Vesical Surgery Chemo Ablative No Organ Surgery Conserving No Operational Policy - Bristol Supra-Regional Testicular Cancer MDT 31

32 Radiation Therapy: No Systemic Chemotherapy: No Intra-Vesical Chemotherapy: No Hormone Therapy: No Systemic Immunotherapy: No Intra-Vesical Immunotherapy: No Brachytherapy: No Cystoscopy: No Biopsy: No Palliative Care: No Active Monitoring: No Referred to Tertiary Centre: No Q22. Pathological Staging: T N M Q23. Date First Treatment: 28/03/2008 Q24. Clinical Trial Status: Q25. Patient Discussed at MDT: Yes Patient Status: Alive 32 Operational Policy Bristol Supra-Regional Testicular Cancer MDT

33 Appendix 5 ASWCS Network Wide Minimum Dataset (MDS) Collection Policy Urological Cancer ASWCS Network Wide Minimum Dataset (MDS) Collection Policy Urological Cancer Measures 08-2G-140 and 08-2G G-241 and 08-2G-242 June 2009 Index Introduction 34 ASWCS Network Wide Minimum Dataset (MDS) Data Collection Policy 35 Page No. ASWCS Network - Trust National CWT Database Upload Timetable March October Data Items 38 National Minimum Dataset (MDS) 38 Operational Policy - Bristol Supra-Regional Testicular Cancer MDT 33

34 Introduction The 6 Trusts in the Avon Somerset & Wiltshire Cancer Services Network (ASWCS) use the Somerset Cancer Register to collect their cancer data. This system has the potential to record all aspects of the National Cancer Minimum Dataset (including Cancer Waiting Times, Cancer Registration and Site Specific elements) plus National Clinical Audit Support Programme (NCASP) audits, Royal College Datasets and South West Cancer Intelligence (SWCIS) audits. Key aspects of Urological Cancer site specific data collection undertaken across the 6 Trusts include all mandatory data items required to be collected as outlined in the National Contract for Acute Services which are:- The cancer waiting times monitoring, including Going Further on Cancer Waits, in accordance with DSCN 20/2008, to the specified timetables. The Cancer Registration Dataset The Trusts may also collect and submit data to the: BAUS (British Association of Urological Surgeons) Audit (Royal College Dataset) - South West Cancer Intelligence Service (SWCIS) Audits Any feedback on this document should be sent to informatics@aswcs.nhs.uk 34 Operational Policy Bristol Supra-Regional Testicular Cancer MDT

35 ASWCS Network Wide Minimum Dataset (MDS) Collection Policy Outlined below is the ASWCS Network Wide Minimum Dataset (MDS) Collection Policy which all 6 Trusts within the ASWCS Network adhere to:- (1) This policy outlines, for the agreed network wide minimum dataset (MDS): - Which team members should collect which portion of the MDS* - When each data item should be collected along the patient pathway - How the data will be stored and managed within all appropriate local data Systems *Please note that who collects which data items will vary from cancer site to cancer site and from Trust to Trust. (2) Different parts of the MDS will be collected throughout the patient journey on different systems e.g. administration, clinical as is appropriate for patient care, and as described below. All relevant cancer data will be recorded if possible on the Somerset Cancer Register bringing together the MDS into one Trust-wide system. (3) Items within this dataset which relate to process elements of the patient pathway will be collected by Trust administrative staff and stored in Trust patient administration systems. This will include data items such as source of referral for cancer and patient pathway identifier. (4) Non clinical patient details, principally patient demographics will also be collected by Trust administration staff and stored within Trust patient administration systems. (5) These process data items and non clinical patient details will be collected throughout the patient pathway as required at the most appropriate point. Referral details such as urgent cancer or symptomatic breast referral type and source of referral for cancer will therefore be collected at point of receipt of referral. Start date (surgery hospital provider spell) would be collected during the part of the patient pathway involving surgery. (6) Where separate systems exist relating to specific elements of the patient pathway, for example theatre or radiotherapy systems, process data items and patient non clinical details will be stored within these systems. (7) Data items relating to waiting times, including going further on cancer waits will be collected throughout the patient pathway. These data items will be collected by Trust administrative staff and stored on patient administration systems or other systems as appropriate within the Trust. (8) Clinical data items relating to specific elements of the patient pathway, principally surgery, radiotherapy, chemotherapy, pathology and imaging will be collected by the clinician responsible for the patient during that part of the patient pathway. These may be stored on separate systems as discussed above in (6). (9) Data items relating to staging, care plan and diagnosis should be collected at MDT where appropriate. These should be collected by the clinician responsible for the patients care. These data items will be stored, electronically where possible, in Trusts systems. (10) Other data items are to be collected by Trust administrative staff and stored in Trust systems providing these data items are non clinical. Clinical data items will be collected by the clinician responsible for the part of the patient pathway, to which the data item relates. (11) Data items must be made available to Trust systems, which transmit the registry dataset to the cancer registry and must be available for upload to the national cancer waiting time database. Operational Policy - Bristol Supra-Regional Testicular Cancer MDT 35

36 (12) All data items must be collected and stored using the codes and classifications set out in the cancer registration dataset or the NHS data dictionary and associated data set change notifications (DSCNs). (13) A Network wide timetable for the submission of Cancer Waiting Times has been agreed and is adhered to by the 6 Trusts in the ASWCS network. This timetables can be found on page 5 of this document. 36 Operational Policy Bristol Supra-Regional Testicular Cancer MDT