SCAN Lung Group Friday 21 st June 2013 14.15 16.15pm Telepresence Suite, Western General Hospital, Edinburgh Present Laura Allan Christine Dodds Martin Keith Felicity Little Kate Macdonald Sheena Mackenzie Eilidh MacRae Tommy Tan Lynda Taylor In attendance Val Doherty Apologies Sandra Bagnall Diana Borthwick Vikki Carmichael Sara Erridge Martin Errington Jakki Faccenda Julie Mencnarowski John Murchison Paul Rafferty Lynn Smith MINUTES Audit Facilitator, NHS D&G Acting Audit Manager, SCAN Senior Cancer Information Officer, NHS D&G Consultant Oncologist, ECC SCAN Manager SCAN Groups and Communications Co-ordinator CNS, NHS Fife Consultant Respiratory Physician, NHS Fife Audit Facilitator, NHS Lothian CNS, NHS Borders Clinical Lead, SCAN SCAN Patient Involvement Manager CNS, NHS Lothian CNS, NHS Dumfries & Galloway Consultant Clinical Oncologist & Honorary Senior Lecturer, ECC Consultant Radiologist, NHS Lothian Respiratory Consultant, NHS Borders Lung CNS, NHS Lothian Consultant Radiologist, NHS Lothian Consultant Physician, NHS D&G Cancer Audit Facilitator, NHS Borders Full list of members on www.scan.scot.nhs.uk Item 1 Introductions, minutes Action The minutes of the meeting on 06/03/13 were approved with one amendment: Page 4: Change Stereotatic Ablative Ultrasound to Stereotatic Ablative Radiotherapy. Matters Arising Tissue samples At the previous meeting, it was noted that lack of tissue SCAN Office, Pentland House, 47 Robb s Loan, Edinburgh EH14 1TY Tel: 0131 465 7682 Mob (meeting days only): 07879 661099 E: sheena.mackenzie@nhslothian.scot.nhs.uk W: www.scan.scot.nhs.uk Page 1 of 7
was hampering lung cancer molecular studies. Radiology colleagues had subsequently confirmed that they were already taking the largest samples they considered advisable. reminded group members that requests/queries for Molecular Pathology should be addressed to the department rather than to William Wallace as an individual. It was noted that there was an generic email address - molecular.pathology@luht.nhslothian.scot.uk. PET referral process At the March meeting, Lothian and Fife confirmed that PET referral processes were satisfactory. Borders had subsequently confirmed that their process was also working well. Dumfries & Galloway reported that in general the system was satisfactory but there were occasional issues with fax requests and the possibility of introducing an e-referral process, as used in WOSCAN, was being explored. Action: Martin Keith to send the WOSCAN PET e-referral policy to Sheena Mackenzie for circulation to the Lung Clinical Leads. Martin Keith Sheena Mac Lung cancer pathway said that he had received no suggestions about altering the position of PET in the regional lung cancer pathway and that the pathway should therefore remain unchanged. 2 SCAN Issues Kate Macdonald updated the Group on regional and national developments, including: Individual Patient Treatment Requests (IPTRs) The Lothian Medicines Management Committee has developed an updated policy for IPTRs which includes contacts for all SCAN boards. Patient information will be developed to ensure informed consent. Quality Performance Indicators (QPIs) and Kate Macdonald attended a national meeting on 14 th March to discuss QPI reporting and review processes in the context of lung cancer audit reports. A report of this meeting is now available. Work to develop reporting and governance processes for QPIs is ongoing. The format of reports will be standardised, target dates for reporting will need to be aligned nationally and key individuals will need to be identified to progress actions. Action: Kate Macdonald to send report of the QPI meeting on 14 th March to Martin Keith. Kate Macdonald The generic patient experience QPIs are expected to be available for consultation in the next 4-6 weeks. A toolkit is being developed to help services carry out the annual patient experience work required by the patient experience QPI. The QPI governance process is to be tested using breast cancer data. NHS Lothian plans to implement a TRAK-based MDM module for all tumour groups over the next 18 months. The Deputy Chief Medical Officer has asked health boards to confirm that processes are in place locally for QPI data collection. CEL (2012) 30: (Revised) Guidance for the Safe Administration of Cytotoxic Chemotherapy Health boards need to complete audits against the CEL by September 2013. In SCAN this work will be Page 2 of 7
co-ordinated by the regional Chemotherapy Group and boards have already undertaken preliminary audits to identify key areas of risk. The CEL requires each board to identify a chemotherapy lead who will have the main responsibility for safe delivery of chemotherapy in their board. New Chair for Regional Cancer Planning Group (RCPG) Tracey Gillies, Associate Divisional Medical Director for NHS Lothian, has been appointed RCPG Chair, replacing Dr Angus Cameron, Medical Director for NHS Dumfries & Galloway. New SCAN Modernisation Manager Christina Lilley has been appointed to provide support for SCAN projects and will be looking initially at radiotherapy capacity and chemotherapy repatriation. Transforming Care After Treatment (TCAT) The formal launch of TCAT was on 13 th June. Macmillan Cancer Support will be providing 4 million over 5 years to support clinical teams and other partners to review, redesign and test new approaches to providing support for patients who have completed their initial treatment for cancer. The guidance for submitting ideas for development projects will be finalised at the TCAT Programme Board on 26 th June and an invitation to submit expressions of interest will be issued thereafter. The National Cancer Survivorship Initiative (NCSI) has produced a report Living with and Beyond Cancer: Taking Action to Improve Outcomes which may be of interest (https://www.gov.uk/government/publications/living-with-and-beyondcancer-taking-action-to-improve-outcomes) Detect Cancer Early (DCE) A national group is considering the order in which the DCE initiative might be rolled out beyond the initial three tumour types (lung, colorectal and breast) and has asked the SCAN Group Chairs to contribute to the scoring process. As yet no further national funding has been committed for the programme. Val Doherty said that a query had been raised at the SCAN Regional Cancer Planning Group (RCPG) about what would happen if the DCE media campaign for lung cancer resulted in increased detection of patients with late stage lung cancer. said that one area in England had found some evidence of a stage shift for SCLC (from extensive to limited disease). Felicity Little said there had been some informal discussions within the cancer centre about the likely impact of the lung cancer DCE campaign but these had focussed on the possibility that more Stage I disease might be detected. 24-hour Chemotherapy Helpline the service was launched as a pilot in Lothian on 10 th June to give patients at risk of developing side effects from their cancer treatment 24/7 access to advice. Specially trained helpline advisers at NHS24 will use a validated triage tool to obtain relevant information about symptoms and decide whether the patient needs advice, follow up after 24 hours by the NHS24 Cancer Team or urgent hospital assessment. Page 3 of 7
3 Lung Cancer Issues Audit Review of action points from 2011 comparative audit report Group members reviewed the action points from the regional report on patients diagnosed in 2011. Improve reliability of audit results by ensuring full coverage of D&G lung cancer population treated in NHS Scotland Martin Keith reported that data collection systems had been improved but there was likely to be an ongoing issue with D&G case ascertainment because some patients receive treatment from NHS Cumbria. Documentation of access to Lung Cancer Nurse Specialists It was noted that Lothian CNSs maintain a database to which Tommy Tan, as Audit Facilitator, has access but that data capture in other areas is less robust. Group members highlighted the limitations of the NQIS standard (referrals to palliative care CNSs are not counted and mentions of CNSs in discharge summaries may not equate to actual contacts with patients). It was noted that access to a CNS had not been included as a Quality Performance Indicator (QPI). Lynda Taylor said that the National Forum for Lung Cancer Nurses was reviewing annual reporting and that she would advise the Chair about the Lung Group s discussions. Action: Lynda Taylor to advise the Chair of the National Forum for Lung Cancer Nurses about the SCAN Lung Group s discussions about documenting patient access to CNSs. Lynda Taylor Improve recording of performance status in Dumfries & Galloway Martin Keith reported that Dumfries & Galloway was now capturing more lung cancer patients but, since many of the additional cases had not come through the MDM, information on performance status for these patients was often unavailable. Increase the percentage of patients with histological diagnoses It was noted that a review of patients not having histological diagnosis in Lothian showed that high case ascertainment linked with advance stage at presentation, age and other co-morbidities, meant that invasive procedures were sometimes inappropriate. Ensure TNM staging is recorded at MDMs It was noted that improvements in recording procedures had been implemented. Increase anti-cancer treatment rates, especially in Fife It was noted a Sara Erridge had undertaken a multivariate analysis of SCAN data for 2010 which showed that, after adjusting for case mix, there were no impacts of deprivation or health board on treatment or survival. (Copy of Sara s conference abstract attached, for info.) Increase percentage of early-stage lung cancer patients having surgical resection The Group noted that there was still no surgical input into the Borders lung cancer MDM and that this situation was unlikely to change. said that in Fife lung patients were triaged for surgical discussion and that it would be preferable to have surgical input for the Page 4 of 7
whole meeting. Kate Macdonald advised that Tracey Gillies, Associate Divisional Medical Director for NHS Lothian, would be discussing surgical rates with colleagues. Increase number of NSCLC Stage III patients receiving radical treatment offered to undertake an audit, if this was not being reviewed already. Actions: Felicity Little to check whether an audit of NSCLC Stage III patients is underway and advise. to undertaken an audit of NSCLC Stage III patients, if this is not already underway. Felicity Little Percentage of surgical patients receiving wedge or segmentectomy It was noted that two patients in Dumfries & Galloway who had received a wedge procedure had been unsuitable for other surgery and were doing well. Improve methods of reporting radiotherapy treatment data to peripheral boards Christine Dodds said that she had found a helpful contact who could assist with queries about radiotherapy and would check whether answering such queries was part of this member of staff s job description. Martin Keith said that access to information on ehealth systems was an issue and that he would ask Graham Gault, as ehealth Lead for SCAN, to look into this. Actions: Christine Dodds to check whether it would be appropriate to share details of her radiotherapy contact with audit staff. Martin Keith to ask Graham Gault to investigate access for audit staff to information on ehealth systems. Christine Dodds Martin Keith Review results on radiotherapy by curative potential It was noted that this issue had been resolved. Action points from national lung cancer networks meeting: Nov 2012 The Group discussed the actions in the draft report from the national lung cancer networks meeting. It was agreed that Christine Dodds and Colin Selby should revise the document and circulate it for final comments. Action: Christine Dodds and to revise the draft report from the national lung cancer networks meeting and circulate it for final comments. Christine Dodds Audit dataset highlighted the need for local and national discussion to ensure consistent collection of any data items outwith the QPI dataset. Christine Dodds said that the QPI dataset should include the fields relevant to NLCA (UK-wide lung cancer audit). Issues raised by Group members included the inability to record extra fields on ecase and differences in data definitions between audit and tracking. Page 5 of 7
Data requests from Pharma Kate Macdonald reported that discussions had taken place between Roche and the Scottish Government about the potential for collaborative working based on chemotherapy data. Roche had been advised that ChemoCare was still in the rollout phase in Scotland and that any such work was some way off. The cancer networks were asked to advise the Chief Pharmaceutical Office about any approaches from Roche to allow any work agreed to be linked together nationally. Workplan The Group reviewed the Group s workplan and suggested a number of updates: Action: Sheena Mackenzie to update the workplan, based on discussions at the meeting, and circulate the revised version for comments. Sheena Mac Update on Lung Cancer Research The Group noted the summary of lung cancer research, provided by Allan Price, and Professor Price s comment that SCAN is recruiting well to the tissue bank study, less well elsewhere. There continues to be a paucity of worthwhile studies from EORTC, NCRI or industry. Much is available for the tiny minority with tumours with single driver mutations and hardly anything for the large majority of patients who don't. This is unlikely to change unless the current structure and funding of research changes. It was noted that Sorcha Campbell had taken over from Allan Price as the lead for lung cancer research. offered to obtain information from Robert Rintoul about a mesothelioma trial and update the Group. Action: to obtain information from Robert Rintoul about a mesothelioma trial and update the Group. SCAN Website Update It was agreed that this item should be deferred until the September meeting and noted that Sandra Bagnall would be having a meeting with Diana Borthwick in the interim. PET-CT Study It was agreed that Alan Simms and/or Dilip Patel should be asked to present the findings of their PET-CT study to a future meeting. Action: Sheena Mackenzie to invite Alan Simms and/or Dilip Patel to present the findings of their PET-CT study to a future meeting. Sheena Mac 4 For Information Summary of Stereotatic Ablative Radiotherapy (SABR) The Group noted the summary about SABR which had been circulated. Felicity Little advised that lack of physics staff was an issue and implementation of SABR could be delayed until late summer. Felicity also informed the group that consideration was being given to extending new radiotherapy techniques, which would allow fields to be shaped more precisely, to Page 6 of 7
Stage III lung cancer patients. 5 Any Other Business There was no other business. 6 Dates of Future Meetings Wed 25 th Sept 2013 Fri 22 nd Nov 2013 All meetings start at 2.15pm and are held at the Western General Hospital with links to RIE and Dumfries. Page 7 of 7