SCAN Gynae Group Thursday 23 rd May 2013

Transcription

1 DRAFT SCAN Gynae Group Thursday 23 rd May 2013 Edinburgh Breast Unit Seminar Room with videolink to Victoria Hospital, Kirkcaldy MINUTES Present Lorna Bruce Kathy Burton Camille Busby-Earle Christine Dodds Nidal Ghaoui Maureen Gallanagh Clare Gorman* Melanie Mackean (Chair) Fiona Nussey Jacqueline Stevenson Alistair Williams Mark Zahra Apologies Awatif al-nafussi Scott Fegan Charlie Gourley Kate Macdonald Jo McGinty Graham McKillop Queenie Menezes Tzyvia Rye Alison Stillie SCAN Gynae Audit Facilitator Cancer Audit Manager, NHS Fife Consultant Gynaecologist, NHS Lothian Acting Audit Manager, SCAN Locum Consultant Gynaecologist, NHS Fife Gynae CNS, NHS Lothian Service Manager, Edinburgh Cancer Centre Consultant Oncologist, Edinburgh Cancer Centre SCAN Groups and Communications Co-ordinator Consultant Medical Oncologist, Edinburgh Cancer Centre Cancer Audit Facilitator, NHS Fife Consultant Pathologist, NHS Lothian Consultant Clinical Oncologist, Edinburgh Cancer Centre Consultant Pathologist, NHS Lothian Consultant Gynaecological Oncologist, NHS Lothian/NHS Fife Professor of Medical Oncology, University of Edinburgh Network Manager, SCAN Gynae CNS, NHS Lothian Consultant Radiologist, NHS Lothian Consultant Gynaecologist, NHS Borders Clinical Trials Data Manager Consultant Clinical Oncologist, Edinburgh Cancer Centre *For Workplan Review item A full membership list is available on Item Action 1 Introductions, apologies, minutes The Group approved the minutes of the meeting on 28 th February Matters Arising Guidance on CA125 referrals The Group noted that GPs were seeking guidance on CA125 referrals and agreed that if the minor amendments agreed at the February meeting could not be made within the next two weeks then the original version should be published on the SCAN website. Action: to ask Graeme Walker if he would be able to amend the CA125 referral guidance by 7 th June. SCAN Office, Pentland House, 47 Robb s Loan, Edinburgh EH14 1TY T: W: sheena.mackenzie@nhslothian.scot.nhs.uk Page 1 of 5 Graeme Walker

2 2 Wider SCAN Issues The Group heard updates on regional and national developments, including: Quality Performance Indicators (QPIs) The QPI governance process is to be tested using breast cancer data. NHS Lothian plans to implement a TRAK-based MDM module for all tumour groups over the next 18 months. CEL (2012) 30: (Revised) Guidance for the Safe Administration of Cytotoxic Chemotherapy Health boards need to complete audits against the CEL by September In SCAN this work will be co-ordinated by the regional Chemotherapy Group and boards have already undertaken preliminary audits to identify key areas of risk. The CEL requires each board to identify a chemotherapy lead who will have the main responsibility for safe delivery of chemotherapy in their board. New Chair for Regional Cancer Planning Group (RCPG) Tracey Gillies, Associate Divisional Medical Director for NHS Lothian, has been appointed RCPG Chair, replacing Dr Angus Cameron, Medical Director for NHS Dumfries & Galloway. SCAN Audit Manager The post of SCAN Audit Manager has been advertised and Christine Dodds has been appointed acting Audit Manager in the interim. Transforming Care After Treatment (TCAT) Macmillan Cancer Support will be providing 5 million over 5 years to support clinical teams and other partners to review, redesign and test new approaches to providing support for patients who have completed their initial treatment for cancer. The following ideas for Gynae pilots were noted: - Roll out of nurse-led follow up for Edinburgh Gynae patients (Fiona Nussey/Alison Stilley) - Psychological support for relapsed ovarian cancer patients (Melanie Mackean) New SCAN Modernisation Manager Christina Lilley has been appointed to provide support for SCAN projects and will be looking initially at radiotherapy capacity and chemotherapy repatriation. Detect Cancer Early (DCE) A national group is considering the order in which the DCE initiative might be rolled out beyond the initial three tumour types (lung, colorectal and breast) but as yet no further national funding has been committed for the programme. 24-hour Chemotherapy Helpline the service will be launched in Lothian on 10 th June and will give patients at risk of developing side effects from their cancer treatment 24/7 access to advice. Specially trained helpline advisers at NHS24 will use a validated triage tool to obtain relevant information about symptoms and decide whether the patient needs advice, follow up after 24 hours by the NHS24 Cancer Team or urgent hospital assessment. Page 2 of 5

3 3 Gynaecology Issues Gynae MDM The Gynae Group approved the revised Gynae MDM protocol and agreed that it should be published on the SCAN website. Action: to publish the revised Gynae MDM protocol on the SCAN website. Melanie Mackean said that she had a medical student who could undertake a review of Gynae MDM decisions if Cameron Martin s student was not able to do this. Optimal Pathway Planning for Joint Pelvic Surgery at the Western General Hospital Melanie Mackean said that David Anderson was arranging a meeting with key stakeholders. She said that Mr Anderson had put forward a suggested pathway and that she could advise on interim arrangements, as required, via the MDM. Audit Quality Improvement Indicators (QPIs) The Group noted the revised list of ovarian Quality Performance Indicators, action notes from the Ovarian Cancer QPI Development Group meeting on 23 rd April and collated comments on the engagement document, which had been circulated with the meeting papers. Melanie Mackean highlighted late stage changes to QPI.4 and encouraged surgical colleagues to provide feedback on these. Melanie Mackean to Camille Busby-Earle correspondence regarding QPI.4 Camille Busby-Earle to liaise with surgical colleagues about providing a SCAN response to the proposed QPI.4 Melanie Mackean Camille B-E Melanie Mackean advised the Group that, while the evidence base for BRCA testing was growing, it was deemed insufficient at present to justify inclusion in the ovarian QPIs. Actions from 2011 comparative report on ovarian cancer Sections 6.8/6.9: Recording of residual disease/surgical FIGO stage It was noted that generally recording of residual disease had improved, but there were still problems in Dumfries & Galloway. The Group agreed that no action was required in relation to recording of surgical FIGO stage. Action: Adrian McCullough to remind colleagues in Dumfries & Galloway about recording residual disease. Adrian McC Section 3.2: Time to laparotomy David Anderson to convene meeting to discuss optimal pathway planning. Page 3 of 5

4 Sections 6.5 & 6.7: Fluid for cytology/omental biopsy 13 out of 37 patients in Lothian with primary surgery for ovary cancer were not identified as potentially malignant due to low RMI and hence did not have omental biopsy and/or washings taken. Work has been taken to report RMI criteria on ultrasounds in Lothian. Camille Busby-Earle noted that these 13 patients represented a small number of the total of benign ovary cysts operated on by gynaecologists and washings for all of these may not be practical. Camille Busby-Earle to raise awareness amongst non-specialists of the need to send fluid for cytology in cases where cancer not suspected. Alistair Williams to liaise with colleagues about adding line to relevant pathology reports when fluid not submitted. Camille B-E Alistair Williams Section 12: Review of patients at MDM It was noted that 8 of the 11 patients not discussed at MDM had been in the care of geriatric medicine. Melanie Mackean cited two recent cases where elderly patients had responded well to treatment and said that she had had offered to contribute to teaching in Geriatrics. It was agreed that the average age of patients not referred to the MDM should be included in the 2012 comparative report. It was agreed that a separate audit of the octogenarian ovary cancer patients and treatment outcomes would help inform any teaching and encouraging of referral patterns. Melanie Mackean reminded the Group that, overall, the audit results showed that ovarian services in SCAN were performing well and that the data presented at the national ovarian cancer networks meeting on 14 th May showed that SCAN was outperforming the other Scottish regions. Melanie Mackean suggested that it would be helpful to be able to compare SCAN s performance with UK-wide data (NCIN National Cancer Information Network) and Christine Dodds offered to explore opportunities for doing this. Action: Christine Dodds to explore opportunities for including SCAN audit data in UK-wide comparisons. Christine Dodds Group Chair Melanie Mackean advised Group members that she would be stepping down as Group Chair at the end of the year and emphasised the importance of identifying someone to take over the role. Action: Any Group member interested in becoming the Chair of the Gynae Group to contact Val Doherty (or Kate Macdonald if Val unavailable.) ALL Patient Representation Melanie Mackean reported that she had identified two possible ovarian cancer patient representatives and that Sandra Bagnall was in the process of making contact with them. She said that she would welcome additional patient representatives with other types of gynae cancer and encouraged Group members to consider whether any of their patients might be interested. Page 4 of 5

5 Group members to send details of any potential patient representatives to Sandra Bagnall. Sandra Bagnall to send copies of the SCAN patient involvement leaflet (when the new version of this is available) to Jo McGinty, CNS, for display in the gynae clinic. ALL Sandra Bagnall Workplan The Group discussed amendments to the workplan to reflect completed projects and new pieces of work. to: - update the Group workplan, as discussed, and circulate the revised version - add links to Target Ovarian information booklets on follow up to SCAN website - check progress with development of core QPIs and feed back to the Group. Nidal Ghaoui and Fiona Nussey to carry out brief patient satisfaction surveys to allow comparisons to be made between the service in Fife and other parts of SCAN. Charlie Gourley to give an update on clinical trials to Sept meeting. Melanie Mackean to seek an update on plans for gynae CNS cover in Fife. Nidal Ghaoui Fiona Nussey Charlie Gourley Melanie Mackean 4 Any Other Business SIGN Guidelines Melanie Mackean encouraged Group members to review the revised SIGN guidelines on ovarian cancer, when available. [Editorial note: According to the SIGN website, the revised guidelines are due to be published in Autumn 2013.] 5 Dates of Future Meetings 5 th Sept 2013 All meetings at 10.00am in the Edinburgh Breast Unit Seminar Room with videolinks available from RIE, D&G and VHK. Page 5 of 5