Somerset, Wiltshire, Avon and Gloucestershire (SWAG) Cancer Services

Transcription

1 Somerset, Wiltshire, Avon and Gloucestershire (SWAG) Cancer Services Upper Gastro-Intestinal and Hepato-Pancreato Biliary (UGI/HPB) Cancer Network Site Specific Group Annual Report 2015 Version 1.0 1

2 This Annual Report was prepared by: Richard Krysztopik, Chair of the SWAG UGI / HPB NSSG Helen Dunderdale, SWAG Cancer Network NSSG Support Manager This Annual Report has been agreed by: Name Position Trust Date agreed Dan Titcomb Consultant Upper Gastro-intestinal University Hospitals Bristol NHS Foundation Trust (UH Bristol) August 2016 Paul Wilkerson Consultant Upper Gastro-intestinal Weston Area Health Trust August 2016 David Hewin Consultant Upper Gastro-intestinal Gloucestershire Hospitals NHS Foundation Trust August 2016 Daniel Pearl Consultant Gastroenterologist Taunton and Somerset NHS Foundation Trust August 2016 Meg Finch-Jones Consultant Hepato- Pancreato-Biliary University Hospitals NHS Foundation Trust August 2016 Steven Gore Consultant Gastroenterologist Yeovil Hospital NHS Foundation Trust August 2016 Version 1.0 2

3 UGI / HPB Contents Section Contents Measures Page 1 Overview, achievements and challenges 1.1 Overview of report Overview of service Achievements and key service improvements over the past 4 12 months 1.4 Challenges for the NSSG 5 2 The Network Group Meeting and Membership 13-1C-102/3n 14-1C-102/3f 2.1 Chair of the NSSG Network Group Membership Attendance Spreadsheet Extended Members of the NSSG Network Group Quoracy 11 3 Service Development 13-1C-104n 14-1C-104f Implementation of The National Cancer Survivorship Initiative The service development function of the NSSG meeting Chemotherapy Treatment Algorithms 5 Patient Experience and Feedback User Involvement Feedback from The National Patient Cancer Experience Survey 13-1C-106n 14-1C-106f 13-1C-108n 14-1C-108f Clinical Outcome Indicators and Audits 13-1C-109n 14-1C-109f 14 Version 1.0 3

4 6.1 The Network Audit for The Network Audit for Clinical quality indicators 14 7 Clinical Trials and 13-1C-110n 14 Research Activity 14-1C-110f 7.1 Discussion of Clinical Trials Recruitment Action Plan Current Clinical Trials Activity Recruitment of Teenagers and Young Adults (TYA) Overview, achievements and challenges 1.1 Overview of report This report reflects the period of activity for the NSSG from 1 st January 2015 to 31 st December It contains a summary of the activity of the UGI / HPB NSSG for this period measured against several key performance indicators that have been outlined in the National Cancer Peer Review Programme. The report should be reviewed alongside three other key documents for the NSSG: the Constitution, Clinical Guidelines and the Work Programme. The UGI / HPB NSSG Constitution provides an overview of how the NSSG operates, outlining the general working processes of the NSSG, the patient referral pathways and the guidelines to which the NSSG adheres. The Clinical Guidelines outline the diagnostic and treatment processes agreed by the network group. The Work Programme summarises the key areas for growth, development and improvement of the NSSG over the next financial year (and beyond where appropriate). All four documents should be reviewed together to give a full overview of the NSSG, its performance and its future plans. 1.2 Overview of service The UGI / HPB site-specific group aims to oversee, support and bring together the viewpoints of all the multi-disciplinary teams working within UGI / HPB cancer services across the Network. The group also aims to ensure the same standard of care and treatment with this type of cancer across the Network. The NSSG works to ensure implementation of NICE guidelines for investigation and treatment of UGI / HPB cancers and to provide guidelines for supportive care. It supports a programme of education on key developments in the field of UGI / HPB cancer. It also aims to continue and expand the clinical trials programmes available within individual trusts. 1.3 Achievements and key service improvements over the past 12 months The following are noted as key achievements and service improvements of the UGI / HPB NSSG over the past 12 months (during 2015): The NSSG has undergone reconfiguration in line with the national cancer clinical networks, inviting Gloucester and Cheltenham NHS Trust to collaborate should they find it of benefit The NSSG has updated the previous network clinical guidelines Version 1.0 4

5 The NSSG has updated the previous network constitution The NSSG has appointed patient representatives The NSSG has agreed a clinical audit The NSSG has improved access to specialist care by involving HPB surgeons in local MDT meetings and fortnightly clinics The NSSG has recruited an additional Consultant Oncologist, Upper GI and HPB surgeon. 1.4 Challenges for the NSSG The key challenges for the UGI / HPB NSSG moving forward are highlighted below: Ensuring that all Trusts in the Network regularly contribute to the educational and audit programmes Continuing to expand and support the clinical trials programme Improving diagnostic capacity Streamlining patient pathways to improve the patient experience Streamlining data collection for National mandatory audits Re-stratification of patient follow up Incorporating the requirements of the Genomic Medicine Centre into practice. 2. The NSSG Meeting and Membership (measures 13-1C-102/103n, 14-1C-102/103f) 2.1 Chair of the NSSG Mr Richard Krysztopik has been the Chair of the UGI / HPB NSSG since A list of responsibilities for the NSSG, for the Chair, and for other members of the NSSG, plus the NSSG terms of reference, can be found in the paper Recurrent Arrangements for Cancer Network Clinical Groups and Responsibilities for Peer Review, as proposed by the (SWSCN) Cancer Network Manager, Jonathan Miller (14 th July 2014): Recurrent-Arrangements-v5-Final.pdf The NSSG meetings are also conducted in line with the Manual for Cancer Services, UGI / HPB Measures, Version Network Group Membership The UGI / HPB NSSG is held approximately every six months. In 2015, meetings were held on the 16 th January 2015 and the 15 th May Attendance Spreadsheet The table below shows the core members of the NSSG and their attendance. All participants at MDTs are welcome to attend the NSSG meetings. Version 1.0 5

6 Table 1.0 UGI / HPB NSSG core members and attendance Trust Name Position Abbadi Reyad Consultant General, Hepatobiliary and Pancreatic NBT Alan Osborne Consultant General Surgery Andrew Hollowood Consultant Oesophago Gastric 16th January th May 2015 Andrew Strickland Consultant Hepatobiliary GLOS Anthony Goodman Christopher Streets Dan Titcomb Consultant Oesophago Gastric Consultant Oesophago Gastric Consultant Oesophago Gastric GLOS David Hewin Consultant General Ian Pope Consultant Hepatobiliary Jeremy Tate Consultant Colorectal NBT Jim Hewes Consultant Colorectal Meg Finch-Jones Consultant Hepatobiliary Obi Nwogwugwu SpR General Surgery Paul Barham Consultant Oesophago Gastric Reyad Abbadi Consultant Hepatobiliary Richard Krysztopik Sally Norton Consultant Oesophago Gastric Consultant Oesophago Gastric GLOS Tony Goodman Consultant General Version 1.0 6

7 William Robb Consultant Oesophago Gastric TST Erica Beaumont Consultant Clinical Oncologist TST Julie Walther Consultant Clinical Oncologist WAHT Serena Hilman Consultant Clinical Oncologist Stephen Falk Consultant Clinical Oncologist Adam Dangoor Consultant Medical Oncologist Matthew Sephton Consultant Medical Oncologist WAHT Tom Wells Consultant Medical Oncologist Ben Colleypriest Consultant Gastroenterologist TST Daniel Pearl Consultant Gastroenterologist and Upper GI Cancer Clinical Lead David Walker Consultant Gastroenterologist John Linehan Consultant Gastroenterologist TST Rudi Matull Consultant Gastroenterologist YDH Steve Gore Consultant Gastroenterologist NBT Talal Valliani Consultant Gastroenterologist Terrence Farrant Consultant Gastroenterologist TST Tim Jobson Consultant Gastroenterologist Tina Mehta Consultant Gastroenterologist and Endoscopist Anne McCune Consultant Hepatologist Fiona Gordon Consultant Hepatologist Peter Collins Consultant Hepatologist Jim Portal Consultant Hepatologist and Acute Medicine Version 1.0 7

8 Julia Maltby Consultant Liver Disease Mark Farrant Consultant Liver Disease TST Emma Cattell Consultant Palliative Care YDH Edwin Cooper Consultant Histopathologist Leigh Biddlestone Consultant Histopathologist Newton Wong Consultant Histopathologist WAHT Richard Daly Consultant Histopathologist NBT Nicholas Rooney Consultant Cellular Pathology Adrian Andreau Consultant Radiologist Andrea Phillips Consultant Radiologist David Wilson Consultant Radiologist Kelly MacDonald Consultant Radiologist Mark Callaway Consultant Radiologist Matthew Laugharne Consultant Radiologist NBT Shoba Philip Consultant Radiologist NBT Graham Collin Consultant Interventional Radiologist TST John Geraghty Consultant Diagnostic Imaging Jonathan Quinlan Consultant Oesophago Gastric in Nutrition YDH Georgina Giebner Macmillan Dietician Tom Lander Dietician NBT David Tate ST4 Doctor Faisal Fayyaz SpR in Gastroenterology Version 1.0 8

9 Allisson Rossiter Oesophago Gastric & Hepatobiliary Clinical Nurse Alison Hepplewhite Bernadette Panes Upper GI & HPB Clinical Nurse GLOS Gaynor Jones NBT Issy Battiwalla Joanna Price Karen Clemett WAHT Karen Low / Endoscopist GLOS Kelly Weir TST Laura Pope Ruth Harding YDH Sue Osborne Upper GI Clinical Nurse Victoria Hunt Hepatobiliary Clinical Nurse Carley Pillinger Upper GI Clinical Nurse TST Margaret O Donnell Upper GI Clinical Nurse YDH WAHT YDH Julie Burton Julie Hutton Robert Lutyens Senior Colorectal / Stoma Care Clinical Nurse Palliative Care Clinical Nurse Lead Acute Oncology Clinical Nurse Angela Webb Senior Research Nurse Joanna Nicklin Research Nurse Sharon Short Research Nurse Version 1.0 9

10 Emily Foulstone Clinical Trials Co-Ordinator Gemma Wham Macmillan Respiratory Cancer Services Tassmin Williamson Macmillan Cancer Support Worker NBT Andrew Heryet Laboratory Manager Cellular Pathology YDH Ian Yell MDT Coordinator YDH Kerry Youe MDT Coordinator TST Nicola Wilson MDT Coordinator WAHT Paula Burge MDT Coordinator Roland Chmielewski MDT Coordinator Tracey Earwaker MDT Coordinator Tracy Smart Hepatobiliary MDT Coordinator Jackie Elliot User Representative Graham Daniel User Representative Administration Helen Dunderdale Cancer Network SSG Support Manager Administration Samantha Larsen Cancer Network SSG Support Administrator 2.4 Extended Members of the NSSG The table below notes the extended membership of the NSSG during 2015 and their attendance at the meetings. Table 1.1 Extended NSSG members and guests attendance Name Role 16 th January th May 2015 Catherine Neck Macmillan Survivorship Lead Lynne Pearson Cancer Manager Hannah Marder Cancer Manager Version

11 Catherine Donnelly Saiwah Mann Mike Osborn Senior Analyst Somerset Cancer Register Analyst Somerset Cancer Register Consultant Psychologist 2.5 NSSG Quoracy The NSSG meetings held on the 16 th January 2015 and the 15 th May 2015 were considered quorate apart from a Consultant Histopathologist was not available to attend the May meeting. The information from each meeting was distributed and the opportunity to participate in the discussion after the meeting was given to all of the core members. TRUSTS/OTHER 16/01/ /05/ TST 2 3 NBT WAHT 1 2 YDH 2 3 GLOS 0 1 Administration 2 1 User representatives 2 1 Extended Membership 2 1 GUESTS 0 3 Total Attendance Version

12 UGI / HPB Attendance 16/01/2015 TST NBT WAHT YDH GLOS Administration User Representatives Extended Membership GUESTS UGI / HBP Attendance 15/05/2015 TST NBT WAHT YDH GLOS Administration User Representatives Extended Membership GUESTS Version

13 3. Service Development (measure 13-1C-103n, 14-1C-103f) 3.1 Implementation of the National Cancer Survivorship Initiative The UGI / HPB NSSG has agreed to conduct a review of patient follow up systems in line with the practices recommended by the National Cancer Survivorship Initiative. Due to the ever increasing population of patients living with and beyond cancer, the current follow up systems are not sustainable, therefore new follow up methods need to be established to provide the support that patients require to lead as healthy and active a life as possible, for as long as possible 1. The UGI / HPB NSSG will work to ensure that all patients have access to the recommended Recovery Package. The Recovery Package consists of holistic needs assessments, treatment summaries and patient education and support events. The UGI / HPB NSSG will also develop risk stratified pathways of post treatment management, promote physical activity and seek to improve management of the consequences of treatment. 3.2 The service development function of the NSSG meeting The NSSG meeting will have an educational function, review major service developments on a regular basis, and escalate operational issues to the Cancer Operational Group and funding issues to the Clinical Commissioning Groups. 4. Chemotherapy Treatment Algorithms (measure 13-1C-106n, 14-1C-106f) An agreed list of acceptable chemotherapy treatment algorithms is reviewed bi-annually and is available to view on the SWSCN website here. Any treatment algorithms that require updating are to be listed in the NSSG work programme. 5. Patient Experience and Feedback (measure 13-1C-108n, 14-1C- 108f) 5.1 User involvement The NSSG has user representative members who are invited to contribute opinions about the UGI / HPB service at the NSSG meetings. The NHS employed member of the NSSG nominated as having specific responsibility for users issues, and information for patients and carers, is the Cancer Network NSSG Support Manager. The NSSG actively seeks to recruit further user representatives. 5.2 Feedback from the National Cancer Patient Experience Survey The results from the National Cancer Patient Experience Survey are included as a recurring agenda item at the NSSG meetings. The results are examined by looking at Trust level best practice to be 1 Version

14 shared, Trust / network level priorities identified for pathway improvements, and the actions required to address identified priorities. The results from the 2015 analysis are within the notes on the SWSCN website here. 6. Clinical Outcome Indicators and Audits (measure 13-1C-109n, 14-1C- 109f) The NSSG aims to regularly review the data from each MDT s clinical outcomes, quality indicators and audits. At least one network audit will be performed each year. The results of this are presented at the NSSG meetings and distributed electronically to the group. 6.1 The network audit for 2015 A network audit was not achieved in A gap in the provision of administrative support for conducting network audits was identified in this inaugural year of the SWAG NSSG Support Service. This will be addressed by incorporating audit related responsibilities in to the service specification. 6.2 The network audit for 2016 The HPB patient s pathway from referral onwards will be audited by Tom Walker. 6.3 Clinical quality indicators The results from the National Oesophago-gastric Cancer Audit (NOGCA) 2014 were discussed in the January 2015 meeting. These showed the mortality rate by Trust for curative oesophagectomies and gastrectomies combined. The results for were not distant from the other Trusts observed. Mandatory completion of a dataset for a quality indicator dashboard relating to HPB services is now required following the decision to commission the service on a national basis. The dataset was submitted for 2014/15. In future, the data fields need to be added to the SCR to improve the data collection process. The results showed that the mortality rate at is lower than the national average, but the majority of patients were admitted with jaundice and were therefore not flagged for managing within the 62 day cancer waiting time target. The current time to treatment was around 100 days. Issues with the capacity of the service need to be identified and improved in the 2016 audit. 7. Clinical Trials and Research Activity (measure 13-1C-110n, 14-1C-110f) 7.1 Discussion of clinical trials Members of the NSSG discuss each MDT s report on clinical research trials within every NSSG meeting. A list of open trials on the UGI / HPB NIHR portfolio, and any potential new trials, is supplied for each NSSG meeting by the West of England Clinical Research Network (CRN) Cancer Research Delivery Manager. Version

15 Due to the CRN s mapping with the Academic Health Science Networks, Taunton and Yeovil are in South West Peninsula CRN. The Cancer Research Delivery Manager from the Peninsula CRN will provide the NSSG with the data for these Trusts. Potential new trials to open and actions to improve recruitment will be documented in the NSSG work programme. The NHS staff member nominated as the research lead for the NSSG is Stephen Falk. Cancer Speciality Specific Objectives: Recruitment overall at 20% of cancer incidences Recruitment to interventional studies at 7.5% of cancer incidence Recruiting local portfolio to include: Surgical trials (4 recruits per 100,000 pop) Rare cancers (12 recruits per 100,000 pop) Children and young people (3 recruits per 100,000 pop) Radiotherapy (6 recruits per 100,000 pop). The Romeo Phase II trial was a success, recruiting the required number of patients, and is now moving to a fully funded Phase III trial. New studies in set up for consideration locally: SCALOP-2 - A multi-centre randomised study of induction chemotherapy followed by capecitabine (+/-nelfinavir) with high or standard dose radiotherapy for locally advanced non-metastatic pancreatic cancer. Closure date: November 2019 ACTICCA-1 - Adjuvant chemotherapy with gemcitabine and cisplatin compared to observation after curative intent resection of cholangiocarcinoma and muscle invasive gallbladder carcinoma (ACTICCA-1 trial) A randomized, multidisciplinary, multinational AIO/DGAV/DGVS phase III trial. Closure date: August Recruitment Action Plan The trials available in each Trust will be updated on the website at regular intervals so that the NSSG members can ensure, wherever possible, that clinical research trials are accessible to all eligible UGI / HPB cancer patients. NSSG members can view potential clinical trials to set up via the following link: Current Clinical Trials Activity A summary of the clinical trial recruitment into National Institute of Health Research trials during 2015 can be found on the SWSCN website here. Version

16 7.4 Recruitment of Teenagers and Young Adults (TYA) There were no TYA patients recruited to UGI / HPB studies in END- Version