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

Transcription

1 Meeting of the SWAG Network Urology SSG Thursday 15 th March 2018, 13:30-17:00 Spire Specialist Care Centre, 300 Park Avenue, Aztec West Almondsbury, Bristol, BS32 4SY Chairs: Mr Jaspal Phull (JP) & Ms Lucinda Poulton (LP) NOTES (To be agreed at the next SSG Meeting) ACTIONS 1. Welcome and apologies Please see the separate list of attendees and apologies uploaded on to the SWCN website here. 2. Review of last meeting s notes and actions As there were no amendments or comments following distribution of the notes from the SSG meeting on 19 th October 2017, the notes were accepted. Actions: Insightful Health Solutions (IHS): The project on enhancing the prostate cancer pathway, presented at the last meeting, is currently on hold. Clinical guidelines: The SWAG Urology Clinical Guidelines for treatment of high risk prostate cancer have been amended from LDR brachytherapy not appropriate to consider pelvic radiotherapy in high risk N0 patient or entry into a relevant clinical trial, as agreed by the Clinical Oncologist members of the SSG. The document will be updated and republished on the website. Cancer Research UK Multi-Disciplinary Team (MDT) Recommendations: After discussion of the CRUK MDT effectiveness report in the last meeting, and the receipt of a letter from Professor Martin Gore, who has been tasked by the National Cancer Taskforce to reform MDTs, the possibility of developing protocols to streamline MDT discussions of low risk patients was raised. These are now being developed by Clinical Policy Managers for NHS England. A regional meeting of cancer leads will convene in July to determine a loco-regional approach to MDT reforms prior to meeting with Prof Gore for further discussions. Urology SSG: Statement of Purpose: The agenda of the SSG will be balanced to meet the priorities of the core participants and the priorities of Cancer Alliance when relevant. It was noted that today s meeting coincides with the Annual European Association of Urology (EAU) Congress in Copenhagen; relevant Congress dates will be added to the SSG meeting calendar to avoid conflicting dates in the future. Page 1 of 7

2 3. Patient pathways 3.1 South West Prostate Cancer Pathway Project Update Please see the Project Update Bulletin uploaded on to the SWCN website Presented by Sarah-Jane Davies (S-JD) The project team who will plan implementation of the recommendations of the PROMIS study has now been appointed: Project Manager: Sarah-Jane Davies Clinical Lead, SWAG: Raj Persad Clinical Lead, Peninsula: Nick Burns-Cox Radiologist Leads: Adrian Andreou (Royal United Hospital Bath), Simon Freeman (Plymouth Hospitals), Paul Burns (Taunton and Somerset Hospitals). Questionnaires have been sent to the Trusts within the region to assess current related practices and capacity. The project team will then visit each centre, aiming to collaboratively develop a best practice pathway that will take into consideration the individual requirements identified via the questionnaire process. A database is being developed to audit reporting of multi-parametric MRI scans; resources have been allocated to facilitate the data entry process. The list of proposed data fields will be circulated. S-JD/ It is hoped that regional standards for image acquisition, MRI reporting, histopathology and operational tasks can be agreed. Anyone who would like to be involved in the work is to contact S-JD: sarah-jane.davies@nhs.net. A South West networking event to discuss the results of the visits, draft guidelines, opportunities, challenges and progress to date will convene in May, and again in September; invites will be circulated by S-JD next week. The project team will regularly update the Urology SSG as the project progresses. S-JD S-JD Offering General Practitioners (GPs) direct access to request an MRI at the time of referral indicated by PSA levels was raised as a possible solution to streamline the patient pathway. This was not currently possible in all centres across the region and, in practice, a proportion of patients referred with a single elevated PSA would not require an MRI. Clear criteria for MRI referral would have to be developed; the frailty index may be useful to add to the referral form for this purpose. It was thought that GPs sometime delegate completion of referrals to other practice staff members. Weston Hospital has slots reserved for rapid access to MRI which are very rarely utilised. Page 2 of 7

3 It should be noted that biomarkers for prostate cancer are being developed that may replace PSA and streamline appropriate referrals in the next few years. NICE guidelines are also due to be updated in the near future that may have an impact on the pathway. 4. Research 4.1 Clinical trials update Please see the presentation uploaded on to the SWCN website Presented by Amit Bahl (AB) and David Rea (DR) Recruitment figures (sourced from EDGE), open trials and trials in set up are documented within the presentation. The national recruitment target for urological cancer is currently 8 per 100,000 of the population served. This is under target to date, due in part to how research participation is allocated. The Add- Aspirin trial has recruited over 100 urology patients to date, but these are not assigned to the urological cancer report. Funding for research support has been reduced in Gloucestershire Hospitals, which subsequently reduced recruitment numbers. Recruitment to time and target has improved from 17% 18 months ago to 73% to date, which will result in an increase in income to the network from the National Institute for Health Research (NIHR). Recruitment targets would ideally be set as a network rather than by individual centres, with co-principal Investigators (PIs) identified (after demonstrating their capacity to engage in research trials) to help promote cross referrals. Data on the patient numbers referred across centres will be presented at the next meeting, and the trials appropriate to open in individual SWAG centres will be assessed. AB/DR Up to date information on open trials will be made available via the SWCN website. A routine request will be sent to PIs to promote their research trials within the SSG research agenda slot, including a link to the research trials on the website when available. 5. Clinical opinion on network issues Rationalising resources/integrating centres Presented by Jaspal Phull (JP) The Urology SSG aims to review surveillance methods, mechanisms and frequency for urological malignancies in each centre over the next calendar year to assess current practice. The intention is to reach a consensus that promotes the same standard of care (rationalised where appropriate) across the region. Page 3 of 7

4 The use of bone scans is already being assessed. Results from an audit in North Bristol Trust and RUH Bath indicate that it could be possible to reduce bone scan frequency in some patients. Further evidence is required from the other centres in the region before the SSG can recommend an agreed standard, in conjunction with a review of evidence from the latest international guidance to ensure that practice is protected from a medico-legal perspective. JP will contact the MDT Chairs to ask for support to collect further data. JP It would also be helpful to review the management of patients with a positive bone scan. There was a need to ensure that patient support services were available with equity across all cancer sites. The different facilities currently available will be shared. 6. Living With and Beyond Cancer (LWBC) 6.1 LWBC Transformation funding and risk stratified follow up Please see the presentation uploaded on to the SWCN website Presented by Catherine Neck (CN) The National Cancer Transformation Board has awarded transformation funding for two years to the South West Cancer Alliances (CA), to increase roll out of the Recovery Package. Funding will be used to recruit Cancer Support Workers to assist with delivery of Holistic Needs Assessments (HNAs) and Health and Wellbeing activity, development of the Somerset Cancer Register (SCR)/ Infoflex to support data collection, implementation of a psychological training programme for all relevant MDT members, improvements in quality for primary care support, and enhancement of cancer rehabilitation services. The Clinical Lead for the LWBC working group is Dr Dorothy Goddard. Further details on the governance of the project and structure of the Cancer Alliance are documented within the presentation. The LWBC working group has been instructed to implement risk stratified follow up pathways for breast, colorectal and prostate cancer, but the scope has not been limited to these cancer sites. Cancer Treatment Summary Templates are being developed at the request of General Practitioners due to their need to keep up to date on the evolving requirements of cancer treatments. Drafts, which have been reviewed by Clinical Oncologist Serena Hillman, will be circulated for comments. A SWAG prostate risk stratified follow up pathway has been drafted in consultation with SSG members and will be circulated for further comments. Implementation of the pathway relies on access to the True North (or similar) IT CN CN Page 4 of 7

5 PSA tracking system. Development of a digital patient information portal, which it was hoped would incorporate this tracking system, is now on hold as NHS England (NHSE) are linking the amount of funds they release to 62 day performance. NHSE are currently withholding 25% of Year 1 funds which will be released retrospectively if future targets are met. All money already committed by the CA will be honoured. It was noted that PSA follow up processes currently varied across the region, with some GPs (mostly within the Bristol area) referring patients back to secondary care for the test, as they are not contracted to provide the service and have no phlebotomy service. Gloucestershire and Somerset do not have the same issues; rural areas were thought to be better set up to provide such services. Changes have already been made to the SCR to incorporate the HNA and some of the other metrics. It is hoped that the SCR, which is also accessible to GPs, can be adapted in a more timely way, now that the SWAG Cancer Alliance has taken a national lead on its development. Project Management support will be made available in Trusts to establish the most beneficial processes for individual centres. 6.2 Holistic Needs Assessments (HNAs) and Care Plans Presented by Carol Chapman (CC) The National Board has decided to collect metrics on the provision of two HNAs for patients; one within 31 days of diagnosis, and one within 6 weeks of completing treatment. The SWAG LWBC working group advised the national team that the 31 day target might not be the most effective time for a patient to have a full HNA. This is now an essential, unchangeable target to secure funding and, while the early HNA was not formally completed, the CNS team do informally discuss needs at that point in the pathway; tools to capture these discussions will be developed and ratified by the LWBC working group. There are fields within the SCR that can be used to record if an HNA has been offered and declined. The targets will not commence on Day 1, but will be assessed at the end of Years 1 and 2. The take home message is to gain recognition for work that is already being completed. Cancer Support Workers are now in post in some Trusts and are assisting with completion of the HNAs, and may well become involved in tracking patient follow up. The next SSG agenda will include a review of surveillance scans and tracking of renal cancer patients. Page 5 of 7

6 7. Quality indicators, audit and data collection 7.1 Time saving modifications to the Somerset Cancer Register (SCR) Presented by Salah Albuheissi (SA) A robust system is required to track patients with bladder cancer who cancel or do not attend post-treatment follow up appointments. It is hoped that the SCR can be adapted for this purpose. It is not possible at present to enter the level of detail to filter the data in the register to look for patients having a cystoscopy, as the procedure is included in the same fields used, for example, to complete a colonoscopy or bronchoscopy. Allowing the individual procedures to be documented would enable these patients to be tracked, mitigating the risk of the patient being lost to follow up. It would also be helpful to document those patients treated with anti-cancer therapies such as BCG and instillation of intravesical chemotherapy. WGH currently use a tracking system independent of SCR. The suggested changes to the SCR will be documented and fed back to Cancer Alliance Manager Jonathan Miller, who is currently gathering information on how to improve the system. In the interim, the lack of a SWAG-wide effective tracking system for non-62 day patients with bladder cancer should be entered onto the Cancer Alliance risk register. SA 8. Service development ,000 Genomes Project Please see the presentation uploaded on to the SWCN website Presented by Catherine Carpenter-Clawson (CC-C) The West of England GMC received their first results for cancer patients over the last 2 months. Many interesting results have been returned for patients in the rare disease arm of the project, which is closing to recruitment in the near future. At a meeting in December 2017, an update was provided on national recruitment to date as documented in the presentation. The recruitment of cancer patients is currently under target due to the complexities involved in processing fresh tissue. Ultimately, the aim would be to open the pathway in all hospital sites for each disease type. National results have shown that 65% of cases processed to date have gene variations with actionable significance. A process of reprocurement commenced in December 2017 aiming to establish seven nationally commissioned Genetic Laboratory Hubs (GLH) by October 2018, when it is planned to transition whole genome testing from a project to standard Page 6 of 7

7 care in the next 5-10 years. A tailored directory of molecular markers that can be used to inform diagnosis, prognosis, and treatment decisions, will be developed and opportunities for clinical trials will be explored. Areas where further evidence on whole gene sequencing is required will be identified and patients consented accordingly. It is hoped to reduce the turnaround time for results to 20 days. Online training is available; for more information on this and any other queries, please contact CC-C: , Ubh-tr.wegmc@nhs.net. Recruitment to the project will remain open until September and the pathways for processing samples are already embedded for other cancer sites; SSG members are encouraged to look into recruiting patients. 9. Any other business A CT guided Cryoablation service for renal cancer is available in NBT. The National Germ Cell Group conference will be held in Bristol on Monday 23 rd April 2018: Referral criteria to the Complex Cancer Late Effects Rehabilitation Service (CCLERS) in Bath will be circulated. A Standard Operating Procedure (SOP) for follow-up of cancer patients transferred between Trusts will be circulated for feedback from the group. Date of next meeting: Thursday 5 th July :30-17:00 -END- Page 7 of 7