APPENDIX 5 OPERATIONAL POLICY UPPER GASTO-INTESTINAL CANCER NETWORK MULTIDISCIPLINARY TEAM

Transcription

1 APPENDIX 5 OPERATIONAL POLICY UPPER GASTO-INTESTINAL CANCER NETWORK MULTIDISCIPLINARY TEAM

2 1. Introduction The National Cancer Standards for Upper GI Cancer Service (2005) states that patients care should be provided by teams of specialists to ensure the provision of high quality care whilst taking account of a range of expertise within different specialities. These multidisciplinary teams are deemed an essential part of the management of patients with cancer, emphasising that an effective well functioning multidisciplinary team will ensure that all relevant disciplines are able to contribute to and participate in discussion and decisions made on the clinical management of patients. 2. Purpose of the Meeting To ensure efficient and high standard of care for patients with Upper GI cancers the Network Multidisciplinary Team (MDT) has been established. The aim of the Network MDT is to ensure a coordinated service for patients from diagnosis to definitive treatment. The Department of Health Cancer Services Standards (2004) define the objectives of an MDT as: (i) (ii) (iii) to enable designated specialists to work together in teams, such that decisions about all aspects of diagnosis, treatment and care of individual patients, and decisions regarding the team s operational policies are multidisciplinary decisions. 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. to ensure that mechanisms are in place to support entry of eligible patients into clinical trials, subject to patients giving fully informed consent as per local policy. 3. Network Specialist Upper GI Multidisciplinary Personnel The core membership of the Upper Gastro-intestinal Multidisciplinary Team should include: Lead Clinician for the MDT Upper gastro-intestinal specific surgeons Oncologist Radiologist Pathologist Gastroenterologist Anaesthetist Clinical Nurse Specialist Dietician Palliative care representative MDT support team Any additional members at the discretion of the MDT Lead

3 3.1 Network Gastro-intestinal Multidisciplinary Team Meeting All patients with a diagnosis of gastric or oesophageal cancer should be discussed at a multidisciplinary team meeting (MDM), the MDM has been identified as the forum to discuss the management of the patients care throughout their journey. The South East Wales Upper Gastro-intestinal Cancer MDM is held weekly every Tuesday at 08.00am, in the Conference Room at Velindre Cancer Centre. The deadline for adding patients to the multidisciplinary team meeting list is Friday 2.00pm. At this meeting the network upper gastro-intestinal multidisciplinary team will review all those patients referred by the local upper gastrointestinal multidisciplinary teams for potential surgery or a second opinion. All patients should be discussed before definitive potentially curative treatment. If there is any uncertainty about whether patients are suitable for potentially curative treatment they should be discussed at the Network MDT. All patients should be discussed after surgery to agree their post-operative treatment plan and correlate pathology to pre-operative staging. All patients who relapse but are suitable for salvage curative treatment should be discussed. 3.2 Roles of Individual Team Members Lead Clinician The lead clinician will act as chair of the meeting and ensure that the discussion is focused and that all patients are discussed. Responsible Clinician The responsible clinician will present the patient to the meeting, lead the discussion, summarise the patient's treatment plan and ensure appropriate follow up. The responsible clinician may be presenting the patient from another site via the use of video conferencing technology. Radiologist/ Histopathologist The radiologist and histopathologist will present all relevant reports when required to aid the discussion of the individual patient. Network MDT Coordinator The Network MDT Co-ordinator will be responsible for listing patients, minuting and distributing the decisions of the MDT, ensuring all notes/xrays/reports/results are available at the MDM for discussion. Liaise with the other sites to ensure all patients referred to surgical centre are discussed.

4 Other Team Members Other team members will contribute to the discussion and agreement of the patient s treatment plan, ensuring that any other patient related issues are taken into account and discussed. 4. Local Upper GI Multidisciplinary Teams The function of the Local Upper Gastro-intestinal Cancer Multidisciplinary Teams are to provide local care and palliative interventions for patients for whom specialist treatment is not appropriate. These teams should maintain an ongoing dialogue with the Network multidisciplinary team to which patients are normally referred, and should also liaise with primary care teams and hospices. Aneurin Bevan Health Board Lead Clinician: Dr M Czajkowski The Aneurin Bevan Upper GI Multidisciplinary team meeting is held weekly on a Thursday at in the Anaesthetic Seminar Room, Royal Gwent Hospital. The deadline for submitting patients to be discussed at the Local Upper GI MDM is Tuesday 12.00md. Cardiff and Vale University Health Board Lead Clinician: Mr W Lewis The Cardiff and Vale Upper GI Multidisciplinary team meeting is held weekly on a Tuesday at 12.00md in the MDT Meeting Room, University Hospital of Wales. The deadline for submitting patients to be discussed at the Local Upper GI MDM is Friday 2.00pm. Cwm Taf Health Board Lead Clinician: Mr X Escofet The Cwm Taf Upper GI Multidisciplinary team meeting is held weekly on a Monday at 12.00md in Rooms 3 & 4 Post Graduate Centre, Royal Glamorgan Hospital. The deadline for submitting patients to be discussed at the Local Upper GI MDM is Friday 3.00pm.

5 5. Primary Care Guidelines for Urgent Referral All patients with any of the following symptoms should be referred urgently to a member of the local multidisciplinary team for investigation: Dyspepsia combined with one or more of the following alarm symptoms: Weight loss Proven anaemia Vomiting Dyspepsia in a patient aged 55 years4 or more with at least one of the following sysmptoms: On set of dyspepsia less than one year ago; Continuous symptoms since onset. Dyspepsia combined with at least one of the following known risk factors: family history of upper gastro-intestinal cancer in more than two first- degree relatives; Barrett s oesophagus; Pernicious anaemia; Peptic ulcer surgery over 20 years ago; Known dysplasia, atrophic gastritis, intestinal metaplasia. Jaundice Upper abdominal mass. 6. Data Collection The MDM offers the opportunity to collect information throughout the patients pathway, therefore as a core requirement all new patients must be entered onto the CANISC database via the MDT Coordinator at the local units. This will ensure all clinical information is collected throughout the patient pathway which will aid the MDM discussion as well as local and national audit. 7. Follow Up All patients will be followed up by the local Upper Gastrointestinal Multidisciplinary Teams in conjunction with the Network Upper Gastrointestinal Multidisciplinary Team.

6 8. Audit The Upper Gastrointestinal Multidisciplinary Team will agree a two year programme of audit to support local, network and national audits; as well has holding a yearly MDT Review Meeting. 9. Local Support Services GEORGE THOMAS HOSPICE CARE Tŷ George Thomas Whitchurch Hospital Grounds Park Road Whitchurch Cardiff CF14 7BQ Tel: Services provided: Community support Information and advice Emotional support for patients and carers Drop-in Centre (Tues, Weds and Thurs) Range of complementary therapies Loan of equipment such as bath aids, wheel chairs, etc. Bereavement support George Thomas Hospice Care provides an on-call service covering out of hours, from 5pm every evening and at week-ends. MARIE CURIE HOLME TOWER Bridgeman Road Penarth Vale of Glamorgan CF64 3YR Tel: Fax: Service provided: In-Patient Unit (short stay and respite) Day Therapy Unit Community support Range of complementary therapies Emotional and Spiritual support Information and advice

7 Hospice of the Valleys Valleys Cancer Care Park Gate Business Centre Morgan Street, Tredegar Blaenau Gwent NP22 3ND Tel: Fax: Service provided: Cancer help clinics Drop-in clinics (9.30am-1.30pm) In patient care Bereavement care MACMILLAN COMMUNITY TEAMS To contact Macmillan Nurses in the: Rhondda Valleys Taff Ely ext 2344 Merthyr & Cynon Valley Bridgend /4 Service provided: Support and counselling Advice on pain management Information about cancer and treatment Access to Day Care or Inpatient care Financial advice and assistance with accessing help Bereavement advice ST ANNE S HOSPICE CARE St Annes Hospice Harding Avenue Malpas Newport NP20 6ZE Tel: ST. DAVID S FOUNDATION HOSPICE CARE Cambrian House

8 St John s Road Newport NP19 8GR Tel: / Fax: Services provided: 24-hour Hospice at Home service Palliative care in-patient unit Education Information and advice Emotional support Family support Day Hospice Bereavement support Day Hospices based at County Hospital, Griffithstown and at Ystrad Mynach Hospital. Resource Centre based at Cheptow Community Hospital. OESOPHAGEAL PATIENTS ASSOCIATION This association offers and provides leaflets, telephone help and advice before, during and after treatment. The association tries, where possible, to encourage former patients to share experiences and advice with current sufferers. Oesophageal Patients Association 16 Whitefields Crescent Solihull West Midlands B91 3NU Tel: Internet: Services provided: Telephone information General information Emotional support/counseling Self-help/support groups