Issue 19 July 2012 In this issue of UPDATE... Dear colleagues, Neurosurgeon Keyoumars Ashkan is leading a clinical trial on brain tumour vaccine page 2 The team led by Professor Amanda Ramirez conducting a review about cancer screening information page 3 Welcome to the July edition of the Integrated Cancer Centre newsletter. As previously, there are many things to report. We are busy planning our next ICC event, bringing staff together to highlight some of our recent achievements and update you on developments. The event will take place on Tuesday, 18th September 2012 from 5.30pm to 7.30pm at the Western Education Centre, King s College Hospital. I hope to see many of you there. The development of the London Cancer Alliance continues. Now that all of the 17 partner trusts have signed the Memorandum of Understanding, the London Cancer Alliance has an official mandate to oversee the development of cancer services across North West and South London. There will be a process of appointing people to key positions to replace the interim chairs of the clinical board and priority pathway groups. A schedule for establishing further pathway groups will also be created. We have a lot to give and a lot to gain from involvement in the London Cancer Alliance. I would encourage staff to play an active part in helping to drive improvements in patient care across the Alliance. We continue to be at the forefront of groundbreaking research; read more about a new brain tumour treatment, which has the potential to delay brain cancer from returning on page 2, and the mesothelioma work Loic Lang-Lazdunski is leading on, featured on page 5. We also hear in this edition from the National Screening Pilot which is led by Professor Amanda Ramirez. I hope you enjoy reading this roundup of our latest news and thank you for your continued support. 60 Seconds interview with Polly Edmonds from King s College Hospital page 4 Professor Arnie Purushotham, Director, Integrated Cancer Centre Loic Lang-Lazdunski changing the way how mesothelioma is treated page 5 For further information on the work of the Integrated Cancer Centre please contact: Dr Fran Woodard Director Cancer and Transformation Programme on 020 7188 7776 or fran.woodard@gstt.nhs.uk Macmillan Information Points Guy s and St Thomas patients are benefiting from new Macmillan cancer information points. The Trust is the first hospital in the South East to have these portable information points that are stocked with plenty of useful leaflets. Patients can pick up a range of information from these portable trolleys, including information about cancer treatments, possible side effects of cancer treatments and other support services that are available. The portable information points were funded by Macmillan Cancer Support and are located in the radiotherapy department at Guy s and St Thomas. Patient-centred, research-driven, clinically-led
2 UPDATE Issue 19 July 2012 New treatment for brain cancer could extend life by two years Pioneering cancer treatment that might double survival times for brain tumour sufferers is being trialled for the first time in Britain. King s College Hospital and King s College London are jointly piloting the therapy, which has already been shown in the US to give sufferers about two more years of life. About 13,000 people are diagnosed with brain cancer in the UK every year, with about half diagnosed with the most common and aggressive type, known as glioblastoma multiforme. The tumour is currently treated with drugs and surgery but the survival time following diagnosis is commonly less than two years. The new treatment works by using a patient s tumour to develop a personalised vaccine. The vaccine, called DCVax, has shown in clinical trials to delay the tumour returning for two years. It also extends a patient s average survival to three years. Cancer vaccines are still a relatively new approach in the fight of cancer and it is exciting that King s Health Partners Integrated Cancer Centre are at the forefront ofthis development. Cancer vaccines encourage the body s own immune system to fight the cancer cell. Traditionally Glioblastoma treatment starts with a surgical procedure, in which neurosurgeons remove the cancerous tissue from the brain. The surgery is usually followed by radiation therapy and then chemotherapy to kill any remaining cancer cells. Many people undergo treatment only to have the cancer return a few months later, at which point doctors may operate again, followed by more chemotherapy. Commonly a Glioblastoma multiforme diagnosis carries a median survival of 12-18 months, with less than 5% of patients surviving longer than two years following diagnosis. Neurosurgeon Keyoumars Ashkan, who is involved in the King s trial, said new therapies were vital for brain cancer The positive data from the clinical trials in the US were very encouraging in delaying disease progression and extending survival times. Neurosurgeon Keyoumars Ashkan said new therapies were vital for brain cancer patients. patients. Brain cancers are some of the most lethal cancers and there is a great need for new treatments, he said. The positive data from the clinical trials in the US were very encouraging in delaying disease progression and extending survival times. The new treatment works by teaching the immune system to recognise, attack, then kill deadly brain cancer cells naturally. Doctors operate to remove as much of the tumour as possible and then use the excised tumour to create an injectable vaccine, which educates the immune system to fight the brain cancer cells when they reappear. Patients will still undergo radiotherapy and chemotherapy but the vaccine uses the body s natural immune response to fight the cancer. Trials have shown the treatment delays the brain cancer returning, allowing patients to live with a better quality of life in the interim. King s Health Partners Cancer Centre at Guy s As part of gaining planning permission for the Cancer Centre, the project team recently held a series of exhibitions showcasing the planned design. There was also a neighbourhood consultation meeting on the 21st April to encourage the local population to get involved. All of the information collated has now formed part of the planning application, which was submitted on the 18th June 2012. The outcome of this application will be available in September.
3 UPDATE Issue 19 July 2012 New biopsy specimen system for Breast Imaging Unit at Guy s and St Thomas In February 2012 the Breast Imaging Unit at Guy s and St Thomas acquired a Faxitron Bioptics core biopsy specimen system for sampling specimens during interventional breast procedures for the diagnosis of breast cancer. The team led by Professor Amanda Ramirez in discussion with patient representatives Dave Morrison and Victoria Nnatuanya about providing choice of information for patients. Informed choice about cancer screening King s Health Partners is playing a lead role in a review of how to offer the public informed choice about cancer screening. Professor Amanda Ramirez and Dr Lindsay Forbes at King s Health Partners Integrated Cancer Centre are leading the independent review, which is seeking to build a new approach to developing information about the NHS Cancer Screening Programmes. The review, which was announced by the National Cancer Director, Professor Sir Mike Richards, was sparked by academic and clinical debate about the information sent to people when they are invited for cancer screening, with critics arguing that it exaggerates benefits and fails to accurately communicate harms. The review is taking place alongside the Marmot review which is considering the benefits and harms of breast screening. To address these concerns the review team is working with academics, charities, health professionals and the public to develop an approach for NHS Cancer Screening Programmes that promotes informed choice. Engagement on the approach is already underway events have been held with representatives of the public, charities and key opinion leaders in the field to explore their views and the review team has already received comments from over 120 individuals and organisations. The review will now build on this engagement, and is seeking the views of the public on the sort of information that should be provided as well as how it is displayed. The results of the consultation and the review team s work are due to be published towards the end of the year, when a new approach to informed choice about cancer screening will be finalised. The team will then take forward this approach, developing information about each cancer screening programme. Early products will include new leaflets to help women to make an informed choice about breast screening. We hope that staff from across King s Health Partners will want to get involved in the review. Professor Amanda Ramirez Professor Amanda Ramirez is Director of the King s College London Promoting Early Presentation Group and the National Clinical Lead for Patient Information. She said: helping people to understand potential harms and benefits of screening is critical in promoting informed choice. It is their health, and it must be their choice as to whether to participate in screening. We hope that the public and health professionals will want to get involved in the review and will register their interest on the website. To find out more about the review, or to feed in your comments, please visit www.informedchoiceaboutcancerscreening.org/ The system is located within the mammography examination room to reduce patient waiting times. The specimen images are displayed on a monitor in seconds of being x-rayed allowing examination times to be kept to a minimum. Julie Scudder, Advanced Practitioner Radiographer said Before acquiring this system, biopsy samples were taken to another mammography room to be x-rayed, which caused a delay in the examination process. Having the new system in the examination room with the patient has reduced examination times by at least 10 minutes per patient. The image quality is very high with added multiple post processing functions enabling visualisation of subtle micro-calcifications. This purchase has definitely improved the standard of service we can offer our patients. King s Health Partners at the Royal College of Nursing Conference A team from King s Health Partners participated in a symposium on improving patient and staff experiences of healthcare using Experience-Based Co-Design (EBCD) at the RCN s International Nursing Research Conference. Professor Glenn Robert from King s College London, who developed this methodology, chaired the symposium with King s Health Partners colleagues contributing to the implementation and evaluation of EBCD.
4 UPDATE Issue 19 July 2012 60 Seconds with Polly Edmonds What is your job title? Consultant in Palliative Medicine and Assistant Medical Director/Cancer Lead at King s College Hospital (KCH). What does your role involve? My day job is a palliative care consultant one of four consultants on the multiprofessional advisory hospital palliative care team at KCH. As one of three assistant medical directors at King s, I have responsibility for cancer and clinical outcomes. What do you think are the key issues for King s College Hospital over the next year? At King s College Hospital our main focus for cancer is on: developing our tertiary cancer services, e.g. neuro-oncology, haemato-oncology, neuro-endocrine and hepato-pancreato-biliary (HPB) to be worldleading in terms of quality and outcomes; achievement of the cancer staging CQUIN, implementation of the KHP best practice guidance for MDMs; delivery of safe and efficient chemotherapy services; development of the acute oncology service; and supporting the integration of the breast units at KCH and GSTT. What challenges do you anticipate over the next year? With KHP operating as a hyper-acute hospital, capacity for cancer activity is constantly squeezed. This puts pressure on cancer waiting times and impacts on quality of care. The planned increase in capacity on the KCH site should facilitate improvements in patient flows and capacity for neuro-oncology and HPB cancers. Across KHP much of the focus is increasingly on influencing the development of the London Cancer Alliance and ensuring that KHP cancer services meet the requirements of the London Cancer model of care. In the current climate, ever-increasing importance is being given to demonstrating excellence in outcomes alongside streamlined efficient, processes so we need to work hard to be able to demonstrate clinically meaningful outcomes, underpinned by research and education so as to be able to describe our services as world-class. National Survivorship Pilot: Colorectal team at Guy s and St Thomas More people are surviving cancer after their initial treatment, increasing the need to ensure patients receive sufficient aftercare to enjoy their lives following treatment. Aftercare for colorectal survivors at Guy s and St Thomas has been adapted to meet these needs. Over the course of 12 months, Roni Cummings, Claire Mcgilly and Louisa Helliard, colorectal nurse specialists, introduced Holistic Needs Assessment (HNA) and Care Planning as part of their routine care and started a new follow-up End of Treatment clinic. At this clinic, patients discuss their concerns following completion of the HNA and with the nurse a treatment summary and individualised care plan is created. For example, asking people their concerns revealed a greater need for help with sexual dysfunction than was previously recognised. The nurses assess which patients are suitable for a self-managed pathway. The self-managed pathway involves routine surveillance tests without the need for the patient to have face-toface appointments. This remote monitoring is facilitated by the Cancer Information System (CIS). Support to self-manage their recovery after treatment also includes an invitation to a patient information day, What s next? Life after Cancer. Two such days have been organised and run by the multi-professional team, with the aim to help people understand their treatment and possible side effects, guidance for their health and wellbeing with exercise and healthy eating as well as knowing what to look out for and who to contact should this be necessary. Patients commented that to see so many of us with the same topic lets you know you are not alone. Professor Richard Sullivan, from the Integrated Cancer Centre delivered a session on chronic diseases in Cape Town, South Africa and the cost curve with Dr Vusi Memela, General Manager of the South African Medical Association, and chaired the prevention debate with Adrian Gore, Chief Executive Officer, Discovery Holdings and Professor Derek Yach, Senior Vice President of Global Health and Agricultural Policy, Pepsi-Cola. Urology nurse specialist to showcase models of care in Asia Lawrence Drudge-Coates, Urological Oncology Clinical Nurse Specialist and Honorary Lecturer, has received a personal invite from nurses in South East Asia to speak about the latest nursing developments in uro-oncology at King s College Hospital. Lawrence, who is also a board member of the European Association of Urology Nurses, will be visiting China and Hong Kong to share good practice with nurses at the First Affiliated Hospital of Guangzhou Medical College. In 2002, Lawrence was instrumental in setting up the first urology nurse-led bone health assessment clinic in the UK, to manage, assess and treat bone metastasis. Since then, the service has gone from strength to strength, involving a number of specialties from across the hospital to help manage other issues related to bone metastasis, such as palliative care and anaemia. The visit will be an opportunity to showcase Lawrence and the urology team s work as well as the changing roles in Urology Nursing and the positive impact that specialist nurses have on patient care.
5 UPDATE Issue 19 July 2012 Influential study on mesothelioma published in the American Journal of Thoracic Oncology Loic Lang-Lazdunski seen as world leading expert on the treatment of cancer caused by asbestos. Guy s and St Thomas surgeon Loic Lang-Lazdunski argues that the less radical pleurectomy/decortication (P/D) intervention should be the dominant treatment type for cancer caused by asbestos. The UK has the highest number of mesothelioma cases in the world. There are about 2,000 to 2,300 deaths in the UK caused every year by mesothelioma, a cancer caused by asbestos exposure. Loic Lang-Lazdunski, a leading surgeon in his field, shows in a recent trial published in the Journal of Thoracic Oncology that the less radical pleurectomy/decortication (P/D) intervention has proven to be more successful and safer in many ways than the extrapleural pnemonectomy (EPP). EPP involves a removal of the entire diseased lung, lung lining, part of the membrane covering the heart and part of the diaphragm. P/D, which is less extensive but more detailed, involves partial removal of the lining around the lung, potentially part of the lung and diaphragm. The study done by Lang-Lazdunski included 76 patients spanning eight years (2004-2011). Twenty two patients underwent EPP and 54 underwent P/Ds. The 30-day mortality rate was 4.5 percent in the EPP group and 0 percent in the P/D group. Within each group, 15 patients experienced post-surgery complications, which translated into 68 percent of the EPP group but only 27 percent of the P/D group. There was no obvious difference in age, gender, histology, pathologic stage and nodal status between the two groups. Most importantly, the survival rate was significantly better in the P/D group than the EPP group, respectively. Other key statistics are: Median survival was 23 months vs 12.8 months; Two-year survival was 49 per cent vs 18.2 per cent; And five-year survival was 30.1 per cent vs 9 per cent for the EPP group. The study was published in the April 2012 issue of Journal of Thoracic Oncology. Loic Lang-Lazdunski argues that this paper will change the way patients with mesothelioma will be treated across the world. He calls for abandoning EPP interventions. We want to hear from you! This newsletter is designed to bring you news about the Integrated Cancer Centre from updates looking at the bigger picture to celebrating successes in our day-to-day services. Do you have a story that you would like to see featured in the next issue? Please email any thoughts or suggestions to Martina Bohn, communications manager at martina.bohn@gstt.nhs.uk