Northern Cancer Alliance. National Optimum Lung Cancer Pathway Event. 23 June 2017

Transcription

1 Northern Cancer Alliance National Optimum Lung Cancer Pathway Event 23 June 2017

2 Meeting: Date: Time: Venue: Lung Event 23 June 09:00 12:00 Registration 08:30 The Crowne Plaza Hotel, Newcastle upon Tyne, NE1 3SA AGENDA INTRODUCTION 09:00 09:15 09:55 Welcome and purpose of the day Dr Tony Branson, Cancer Alliance Clinical Lead National Optimal Lung Pathway Dr Sadia Anwar, Respiratory Physician Nottingham University Hospitals NHS Trust Radiology Advanced Practitioner - CXR Reporting Project Nicholas Woznitza, Advanced Practitioner, Hommerton University Hospital NHS Foundation Trust, East London. 10:15 Coffee Break 10:30 10:50 Ambulatory Lung Biopsy Dr Samanjit Hare, Consultant Chest Radiologist/Trust Lead for Thoracic Radiology, Royal Free London NHS Trust Radiology Upgrade Dr Ralph Marsh, Consultant Radiologist City Hospitals Sunderland NHS Foundation Trust 11:10 Panel Q&A and future action plan. 11:50 Next steps Dr Tony Branson 12:00 Close

3 Triage system for referrals to the lung cancer service: secondary care leads the management process This pathway places the responsibility for managing all patients referred for suspected lung cancer within secondary care. It ensures patients with other conditions that may require secondary care are given appointments and patients not requiring secondary care are directed back to primary care without the need for an outpatient appointment in secondary care

4 Triage system for referrals to the lung cancer service: primary care leads the management process This pathway places the responsibility for managing patients that are unlikely to have lung cancer within primary care following a CT report that is not suspicious for lung cancer. This means fewer non-lung cancer patients are seen by the lung cancer services but relies on management of other conditions in primary care.

5 $ There is no agreed definition of borderline fitness. NICE QS 17 (Lung Cancer) defines this as a level of fitness that could lead to a greater than average morbidity or mortality from surgery. However, modern radiotherapy techniques mean that assessment for curative treatment can be applied at lower levels of fitness than defined in QS17.

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9 Next steps on the NHS five year forward view. March 2017 Optimal Lung Pathway - Action Plan Faster tests, results and treatment for people with worrying symptoms. Expand diagnostic capacity so that England is meeting all 8 of the cancer waiting standards, compared to seven out of eight today. We will focus specifically on the cancer 62-day from referral to treatment standard ahead of the introduction of the new standard to give patients a definitive diagnosis within 28 days by Achieving world-class cancer outcomes: a strategy for England TRUST : Recommendation 24: By the end of 2015, NHS England should develop the rules for a new metric for earlier diagnosis measurable at CCG level. Patients referred for testing by a GP, because of symptoms or clinical judgement, should either be definitively diagnosed with cancer or cancer excluded and this result should be communicated to the patient within four weeks. The ambition should be that CCGs achieve this target for 95% of patients by 2020, with 50% definitively diagnosed or cancer excluded within 2 weeks. Once this new metric is embedded, CCGs and providers should be permitted to phase out the urgent referral (2-week) pathway. COMPLETED BY: PATHWAY STANDARD MET IF NOT MET, PROCESS STEPS TO IMPLEMENT IMPROVEMENT INVESTIGATION CXR: Is there GP or IP access to urgent CXR in your trust? [within 1 working day] Are abnormal CXRs reported within 24 hours? Is a written report received by the referring clinician within 1 working day? Do you have Radiographer Advanced Practitioners to report CXR s? Do you have a team of radiologists who specialise in reporting CXRs?

10 Abnormal CXR: DIAGNOSIS If a CXR is suspicious of cancer do you have a protocol to initiate a CT scan of the chest? If yes is the CT scan performed on the same day or within 72 hours of the CXR? Will the CT scan be performed before or on the day of the respiratory outpatient appointment? Do you have systems in place to communicate results of the abnormal CXR/CT to the patient and their GP? Do you have a system to track patients with abnormal CXR suggestive of cancer to ensure that they are investigated and followed up appropriately? For inpatients with an abnormal CXR or a clinical suspicion of lung cancer, is a CT chest be performed within 24 hours if clinically indicated? Abnormal CT chest: Histology: Is there a triage process to manage abnormal chest CT results i.e. to fast track patients with suspected lung cancer? If the CT scan suggests lung cancer, is there a protocol to initiate other investigations needed to plan treatment, including PETCT, scan, lung biopsy etc? If the CT is abnormal can you provide a direct biopsy service on the same day or within 3 days if clinically appropriate? If a CT scan suggests non curative lung cancer, is there a protocol to guide what further investigations are appropriate [i.e. test that will influence treatment] If CT scan does not suggest lung cancer is the patient informed of this and any other actions within 28 days. For inpatients with suspected lung cancer, are they seen within 48 hours by acute oncology, respiratory or palliative care services? Are biopsy results available within 3 days for subtype and 10 days for molecular markers?

11 CHEST CLINIC OUT PATIENT APPOINTMENT (OPA) Is the patient informed of a cancer diagnosis within 28 days? Is the Lung CNS available in clinic when the patient is informed of a cancer diagnosis? Can you get a PETCT investigation and report within 7 working days of the OPA? Can you get detailed lung function tests, ECHO and cardiac assessment within 14 days of the chest clinic appointment if clinically indicated? Is there any diagnostic or treatment planning before the OPA? Is there a process for early notification of oncology or thoracic teams to facilitate scheduling procedures/clinic appointments? Is the first OPA with the treating specialist (oncologist, surgeon) within 3 working days of the respiratory OPA? MDT: Where the clinical picture is straightforward/protocol driven, can the patients treatment/further investigations be arranged prior to or in tandem with the MDT discussions? Do tertiary centres accept referrals whilst awaiting PETCT results? Does the MDT discuss all patients every time or only those requiring a discussion that would influence their treatment? When transferring patients to the tertiary centre are they transferred by day 35? [Inter Provider Transfer date].

12 Delegates List Forename Surname Organisation Rashid Abbasi County Durham & Darlington NHS Foundation Trust Vicki Anderson Newcastle upon Tyne Hospitals NHS Foundation Trust Sadia Anwar Nottingham University Hospitals NHS Trust Darren Archer NECS Philip Atherton Newcastle Upon Tyne Hospitals NHS Foundation Trust Sally Athey Gateshead Health NHS Foundation Trust Cynthia Atkin Northern Cancer Alliance Angela Atkinson CRUK Michelle Barclay Gateshead Health NHS FT Sion Barnard Newcastle Upon Tyne Hospitals NHS Foundation Trust Jo Battenbo South Tyneside NHS Foundation Trust Fiona Black Newcastle Upon Tyne Hospitals NHS Foundation Trust Steve Blades Tony Branson Cancer Alliance Delphine Brown County Durham & Darlington NHS Foundation Trust Hilary Brown Northumberland CCG Jackie Brown North Tees & Hartlepool NHS Foundation Trust Karen Capenhurst County Durham & Darlington NHS Foundation Trust Naomi Chamberlin City Hospitals Sunderland Henry Choi Sunderland CCG David Cooper Northumbria Healthcare NHS Foundation Trust Andy Copeland Hartlepool and Stockton, Darlington DDES Sharon Cornwell NECS - Cumbria Natalie Cummings County Durham & Darlington NHS Foundation Trust Sarah Cummings CDDFT Mamatha Devaraj South Tees Hospitals NHS Foundation Trust Jeanette Draffan North Tees & Hartlepool NHS Foundation Trust Vytis Dudzevicius South Tees Hospitals NHS Foundation Trust Tom Dunkerton North Tyneside Clinical Commissioning Group Katie Elliott CRUK /Cancer Alliance Lauren Farrow South Tees Alison Featherstone Cancer Alliance Jonathan Ferguson South Tees Hospitals NHS Foundation Trust Isobel Finlay South Tyneside NHS Foundation Trust Tessa Fitzpatrick North Tees & Hartlepool NHS Foundation Trust Jill Forster City Hospitals Sunderland Liz Fuller South Tyneside NHS Foundation Trust Michaela Golodnitski NHS Scarborough and Ryedale CCG/HRW CCG John Gorman CRUK Anne-Louise Grant County Durham & Darlington NHS Foundation Trust Bill Hall South Tyneside CCG John Hancock North Yorkshire and Humber Commissioning Support Unit Carolyn Harper Gateshead Health NHS Foundation Trust Paul Harrington Cumbria

13 Richard Hartley South Tees Jenny Hicken NHS England Louise Hobson Newcastle Upon Tyne Hospitals NHS Foundation Trust Jan Hughes South Tees Kumud Jain Gateshead Health Vandana Jeebun North Tees & Hartlepool NHS Foundation Trust Kath Jones Cancer Alliance Mark Katory Gateshead Health NHS Foundation Trust Jeremy Killen Gateshead Health NHS Foundation Trust Sarah Kucukmetin CRUK Vicky Lamonby North Cumbria University Hospitals NHS Trust Matthew Lane North Cumbria University Hospital Neil Leitch North Tees & Hartlepool NHS Foundation Trust Nicola Lloyd South Tyneside Jo Mackintosh Cancer Alliance Michelle Mangan Newcastle Upon Tyne Hospitals NHSFT Roya Marley South Tyneside Ralph Marsh City Hospitals Sunderland NHS Foundation Trust Steve Maxwell South Tyneside NHS Foundation Trust Claire McNeill Cancer Alliance Fiona McQuiston CRUK Jacky Melrose Gateshead Health NHS Foundation Trust Robert Milner NECS Adrienne Moffett Cancer Alliance Nicky Moon Northumbria Healthcare Judith Moore Michelle Muller Newcastle Neil Munro County Durham & Darlington NHS Foundation Trust Parag Narkhede Northumbria Martin O'Callaghan Northumbria Peter Orr CDDFT Claire Oxley South Tees Hospitals NHS Foundation Trust Sarah Perkins County Durham & Darlington NHS Foundation Trust Susan Pollock City Hospitals Sunderland NHS Foundation Trust Sharron Pooley North Tees & Hartlepool NHS Foundation Trust Sathyamurthy Ramamurthy South Tees Anne Richardson Cancer Alliance Spencer Robinson South Tees Hospitals NHS Foundation Trust Jackie Robson South Tees NHS Trust Christine Rushton Newcastle Upon Tyne Hospitals NHS Foundation Trust Clare Scarlett North Tyneside CCG Mitul Sharma County Durham & Darlington NHS Foundation Trust Sharon Smith CRUK Yuki Smith Hartlepool & Stockton CCG Jackie Spensley Newcastle Upon Tyne Hospitals NHS Foundation Trust Chris Tasker Newcastle North and East CCG Ian Taylor City Hospitals Sunderland NHS Foundation Trust Leah Taylor Northumbria Healthcare Lilian Taylor North Tees

14 Lou Thai Gateshead Benjamin Tulloch CDDFT Amanda Walshe Northumbria Healthcare NHS Foundation Trust Ann Ward Newcastle Upon Tyne Hospitals NHS Foundation Trust Louise Watson Cancer Alliance Mark Weatherhead Northumbria Healthcare NHS Foundation Trust Felicity White Northumbria Healthcare NHS Foundation Trust Lee Whitfield South Tyneside Foundation Trust Lena Wilkinson Northumbria Sophia Williamson Gateshead Health NHS Foundation Trust Linda Wintersgill Cancer Alliance Phil Woolfall North Tees & Hartlepool NHS Foundation Trust Janice Worton South Tees Hospitals NHS Foundation Trust Nick Woznitza Homerton University Hospital NHS Foundation Trust Michelle Wren NHS england Patrick Wright North Durham CCG