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March 07 - Welcome to the homepage of the Arden Cancer Network

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March 07 - Welcome to the homepage of the Arden Cancer Network ...

     Quarterly Newsletter March 2007

FOREWORD

    Welcome to this edition of the Arden Cancer Network Quarterly Newsletter. As you can see from the excerpts from the various tumour site groups, etc., there is a lot of focus currently on driving forward the Improving Outcomes Guidance in a number of tumour sites. This includes concluding implementation of the IOGs in urological and gynaecological cancer, moving forward the implementation of the haematology IOG (subject to successful outcome of funding in the current LDP round), planning the configurations of skin cancer services and also colorectal services in response to this revised IOG. The Network has also been successful in securing support from the West Midlands Rarer Tumours Group for the continued development of Hepato-biliary cancer services at UHCW.

    In March the Network submitted an application to become a second wave bowel screening centre, as the Rugby pilot ends. We are delighted that this bid has been approved by the Department of Health. In addition the Network has supported the development of local solid tumour chemotherapy at Warwick, which is planned to go live in April 2007.

    I am grateful for your continuing support in implementing these exciting service developments across the Network for the benefit of our patients.

Y:QNewsletter/January March 2007 Page 1 of 11

    thBreast NSSG Last meeting held on 6 March 2007 at Warwick Hospital.

    ? Breast cancer follow-up is currently being reviewed by the

    NSSG and will have implications for commissioning. No further

    progress to date.

    ? Network-wide protocols have been drafted;

     SNLB in-patients with DCIS.

     Family history surveillance

     Guidelines for the use of aromatase inhibitors

    ? A very successful Breast Cancer Update for GPs was held on

    7.3.07 at Ryton Organic Gardens. The programme included

    breast screening, diagnostic process and appropriate 2 week

    wait referrals, surgical techniques, breast reconstruction,

    chemotherapy/adjuvant hormone therapy/clinical trails, and the

    role of the Breast CNS. All sessions evaluated extremely well

    and there have been requests for a repeat session in the near

    future.

    ? The appointment of a new chair for the Breast NSSG is

    currently under discussion.

    Date of next meeting to be confirmed.

    thColorectal Last meeting held on 30 January 2007 at Warwick Hospital.

     NSSG

    ? The principal focus of the last Colorectal NSSG was to review in

    detail the revised peer review measures. An update was given in

    respect of Hepato-biliary services in that the West Midlands Rarer

    Tumours Group has agreed that UHCW should be given a 2 year

    period to develop its HPB service, in line with advice from the

    Department of Health.

    ? The group agreed to proceed with Quasar 2 clinical trial, but to

    discuss the pros and cons of proceeding with the Chronicle trial at

    the next meeting.

    ? Ron Parker updated on the Colorectal Screening bid, noting that

    going forward was subject to successful JAG visits and

    achievement of Global Rating Scale criteria, including waiting

    times. Due to a problem with waiting times at George Eliot, it was

    likely that screening at GEH would be deferred and the North

    Warwickshire population would be screened at Coventry in the

    interim period.

    ? Paul Murphy suggested that the measures within the National

    Bowel Cancer Audit could be reviewed locally across the Network.

    ? Cancer waiting times were achieved for both 31 and 62 day

    targets.

     thDate of next meeting 25 April 2007

    Y:QNewsletter/January March 2007 Page 2 of 11

    stGynaecology Last meeting held on 31 January 2007 at Warwick Hospital.

     NSSG

    ? The transfer of activity from Redditch to the Centre is

    completed. Dr Irwin and Mr Sant Cassia attend the MDT prior

    to the clinic on a fortnightly basis; the arrangement is working

    well.

    ? It was confirmed that a third gynae-oncologist, Mr Athavale, has

    been appointed and is due to commence in post April/May.

    ? It was agreed that the SMDT will take place on Friday

    afternoons, using video conferencing facilities where

    appropriate.

    ? Linda Wimbush updated the group on clinical trials activity

    across the Network.

    ? A service improvement report was presented identifying work

    on PMB pathway at Redditch, last 10 patient audit at Redditch,

    development of timed patient pathways at all sites and review

    of action plans for Peer Review.

    ? A cancer waiting times report showed the 14 day and 31 day

    targets were achieved in December 2006, but the 62 day target

    was not achieved.

    ? Agreement on the 2007 meetings schedule.

     thDate of next meeting 17 April 2007

    thHaematology Last meeting held on 9 November 2006 in the CSB, UHCW.

     NSSG

    ? A pathway for the management of neutropenic sepsis was

    discussed and feedback from Warwick and George Eliot Hospitals

    was requested for the next meeting. ? It was noted that the Network Pharmacist would support the role of

    the Drug and Therapeutic Group for the Network and also link into

    the Network Commissioning Group. ? UHCW is developing a Patient Information Prescription service,

    akin to the national pilots.

    ? In respect of the Improving Outcomes Guidance for haematology,

    progress was being made in respect of clarifying the cost and

    income relating to the activity which would transfer to UHCW from

    Warwick for complex haematological patients. Once finances had

    been agreed, further meetings would need to take place to move

    forward the operational arrangements for the transfer of this work.

    ? The NSSG received an audit presentation from Dr Cader in

    respect of CML. This audit concluded that the Network was

    compliant in respect of NICE guidelines, and also demonstrated

    the success of Glivec drug therapy.

    Y:QNewsletter/January March 2007 Page 3 of 11

    ? Rebecca Burt updated on clinical trials activity across the Network.

    ? Waiting times for haematology 100% for both 31 and 62 day

    targets.

     thThe date of the next meeting Thursday 8 March 2007.

    thHead & Last meeting held on 18 January 2007 at UHCW.

     Neck NSSG

    ? It was noted that a joint peer review will be held for UHCW and

    Heartlands. An action plan will be developed and discussed at

    subsequent NSSGs.

    ? It was identified that the DAHNO uploads occur in a reasonably

    timely manner; some improvement still required. ? Agreement was reached for a joint audit with UHB, and that a

    joint last 10 patient audit will be led by Alison Barry at Pan

    Birmingham which will involve patients with laryngeal or oral

    SCC.

    ? Mr H. Mehanna presented the Refeeding Syndrome audit. ? Mr H. Mehanna informed the group that the PET Neck trial has

    received approval by NCRI and is to start in April. ? Cancer waiting times targets were achieved in November 2006.

    ? An audit of the timed patient pathway was presented.

     thThe date of the next meeting is 19 April 2007.

    rdLung NSSG Last meeting held 23 January 2007 at Parkside House.

    ? Mr Joe Marzouk was confirmed as chair of the NSSG. ? Dr Hugh Antrobus presented his proposal for the development

    of a Percutaneous Cordotomy Pain Service to be based at

    Warwick Hospital. Potentially this could become a regional

    service and Dr Antrobus and Angie Arnold agreed to speak

    with our neighbouring Networks i.e. 3 Counties Network, Pan

    Birmingham Network, Greater Midlands Network, and

    Leicester, Northampton and Rutland Network regarding

    potential activity.

    ? The NSSG agreed a Network-wide audit on lung resection

    rates. It was agreed that resection rates from each MDT could

    be collected and benchmarked against other Networks. A

    future audit had been identified as GP 2 Week Wait Referral

    compliance with the NICE Guidelines.

    ? Upgrades to the Unisoft Systems at GEH and Alexandra

    Hospital have been ordered which will enable data to be

    uploaded on to the Lucada Database.

    Y:QNewsletter/January March 2007 Page 4 of 11

     Each Trust will need to identify the person responsible for

     keeping Lucada up to date.

    ? A sample of at least 10 patients within each Trust will be

    reviewed to assess if each patient reached target dates on the

    pathway for consultation, diagnosis and treatment. ? The Network leads for Mesothelioma are Dr Caroline Humber

    and Dawn Beaty. The Cancer Action Team have circulated a

    paper on the Mesothelioma framework for consultation. The

    key principles of this framework are: that mesothelioma

    patients should be diagnosed as early as possible, offered

    radical treatment where this is appropriate, have access to

    palliative care interventions, and be offered appropriate

    information and advise including possible compensation. Key

    recommendations include all MDTs that manage mesothelioma

    patients participate in the national lung cancer audit

    programme (LUCADA); all mesothelioma patients have a key

    worker (this is like to be the Lung CNS initially); and PCTs in

    areas associated with asbestos related industries/high

    mesothelioma incidents consider targeted local initiatives in

    primary care.

     thDate of next meeting moved to 26 April 2007.

    stSkin NSSG Last meeting held on 1 February 2007.

? Considerable concern has been expressed by clinicians within

    the Skin NSSG around non-compliance of the 2 week wait

    referral system for skin cancer. These issues will be raised

    with the PECs in Coventry and Warwickshire and also with the

    PCT clinical governance leads.

    ? Richard Carr presented a Network-wide audit on GP BCC

    excision and comparison with hospital specialists at South

    Warwickshire NHS Trust. This consisted of a retrospective

    audit of pathology reports; all BCCs excised by GPs and

    reported at SWH and GEH for 2005; all BCCs excised by GPs

    and reported at UHCW for 2005/2006 excluding January to

    March 2005; and all BCCs excised by either plastic surgeons or

    dermatologists (hospital specialists) and reported at Warwick

    Hospital 2005. The summary of the results included that the

    hospital specialists suspected malignancy in at least 95.4% of

    cases compared to only 53.1% of cases for GPs. Hospital

    specialists failed to suggest a diagnosis in only 3.2% of cases,

    compared to 28.5 % of cases submitted by GPs.

     Hospital specialists excised 86.6% of BCCs with ? 1mm

     margins compared to only 46.5% for GPs.

    Y:QNewsletter/January March 2007 Page 5 of 11

     Margins were positive in only 6.2% of cases excised by hospital

     Specialists compared to 24.7% for GPs. In conclusion GPs

     would require substantial further training in education if

     accuracy of diagnosis and adequacy of excision is to match that

     of hospital specialists.

    ? Draft guidelines for the management of Cutaneous T Cell

    Lymphoma have been discussed. This also needs to be

    ratified within the Haematology NSSG.

    ? Skin IOG: Further special meetings have been held to discuss

    the development of the Skin IOG Action Plan. Local MDTs are

    well established. The site of the specialist MDT is yet to be

    decided. Further guidance is expected from the DoH on

    training and accreditation of a GPwSI. Models of community

    skin oncology services are to be explored further with clinicians

    and commissioners. It is noted that GPs with Special Interest

    [GPwSI) would be required to attend 4 MDT meetings per year.

     thDate of next meeting 20 March 2007.

    thUpper GI Last meeting held on 29 January 2007 at UHCW.

     NSSG

    ? The group is looking at potentially splitting the tariff to allow local

    scanning of patients who receive treatment at UHCW. ? Updates were provided from the West Midlands Supra Network

    NSSG for Hepato-biliary cancer and also the West Midlands Rarer

    Tumour Group into which it reports, noting that agreement had

    been reached across the West Midlands for a 2 site model for liver

    cancer i.e. at University Hospital Birmingham and UHCW; and a 3

    site model for pancreato-biliary cancer, with a service also being

    provided at University Hospital North Staffordshire. The HPB

    Supra NSSG will be developing audit criteria to evaluate the West

    Midlands services within a 2 year review period. ? The NSSG discussed an audit of oesophageal stents and

    discussions are ongoing to establish a prospective audit across the

    Network.

    ? Cancer waiting times were achieved for 31 and 62 days at 100%

    for November 2006 and Ian Fraser requested that the Trust collect

    separately HPB waiting time data in order to feed this into the

    West Midlands Group.

    ? The NSSG will be seeking to elect a new Chair at subsequent thmeeting on 16 April 2007.

     thDate of next meeting Monday 16 April 2007.

    Y:QNewsletter/January March 2007 Page 6 of 11

    thUrology Last meeting held on 14 June 2006 at Warwick Medical School, Warwick Hospital. NSSG

    ? The start date for the Arden Cancer Network Urology SMDT is thWednesday April 4 2007, to follow the local MDT.

    ? The patient flows for interstitial brachytherapy were agreed.

    ? The group agreed that the 2 week wait referral forms were

    working well across the Network.

    ? An audit is agreed on the numbers of radical surgery and who

    operates. A Network wide audit on radical treatment for

    prostate will also commence.

    ? Cancer waiting times were achieved for the 14, 31 and 62 day

    targets across the Network.

    ? A report on service improvement was delivered to the group

    which covered a last 10 patient analysis across the 3

    Worcester sites, analysis of TURBT at Worcester, timed

    urology pathways at Redditch and an audit of patient diaries.

     thDate of next meeting: Wednesday 13 September 2006 at Warwick

    Medical School, Warwick Hospital.

    THPalliative Last meeting held on 15 January 2007 at Myton Hamlet Hospice

     Care

    ? Palliative Care Schemes, which had been agreed in September Strategy

    2006, were still unable to go ahead due to non-payment of Group and

    outstanding invoices from Warwickshire PCTs. Palliative

    ? It was noted that, in future, the term „palliative care‟ may be Care Clinical

    superseded by the term „end of life care‟. This may have Sub Group

    implications for the way in which schemes were presented and

    subsequently funded.

    ? The NHS Warwickshire PCT have notified the Warwickshire

    Palliative Care Team of its intension to review the service.

    ? The Supra-Network Paediatric Palliative Care Group had now

    been set up, and has a wide remit covering the whole spectrum

    of life limiting conditions for children. Angela Thompson and

    Angie Arnold have been invited to attend. The local paediatric

    palliative care service was working well, with a lead nurse for

    both Coventry and Warwickshire.

    A Palliative Care Clinical Group has been developed as a sub group thof the Palliative Care Strategy Group and met for the first time on 15 January 2007.

    Y:QNewsletter/January March 2007 Page 7 of 11

    Membership of the group has been extended to the clinical leads from

    the cardiac and renal networks.

    Issues raised within the group include:

    ? Network-wide protocols for syringe drivers ? Information for the recently bereaved

    ? Network-wide protocol for spinal cord compression ? Non medical prescribing

    ? Out of Hours access to drugs

    ? Percutaneous Cordotomy service development ? Education and training

    ? Psychological support service development - 2 Macmillan

    funded psychologists are now in post 1 will be based at

    Warwick Hospital and link into Redditch and Bromsgrove, the

    other postholder will be based at GEH linking into UHCW. Job

    plans are still under discussion but will include a Network-wide

    skills audit of psychological support and the pilot of the Distress

    Thermometer which measures patients anxiety. ? End of Life Project several GP practices in Coventry have

    now signed up for the Gold Standards Framework. One ward

    at the GEH is implementing the Liverpool Care Pathway.

    Currently Linda Vowles is working with the care homes in

    Coventry and Rugby.

     thDate of next meeting 19 March 2007 at Myton Hamlet Hospice.

    thDrug & Meeting held on 25 January 2007 at UHCW.

     Therapeutics

    ? Herceptin policy amended as per NICE guidelines revision Group

    ? Network chemotherapy Strategy discussed and amendments

    proposed

    ? Sue Marsh reviewed compliance with NICE Technology

    Appraisals

    ? Chemotherapy guidelines being developed across all tumour

    sites

    ? Sue Marsh tabled drug horizon scanning document ? Non-formulary drug usage reviewed

    ? Rebecca Burt updated on trials activity across the Network ? Examples of untoward incidents were discussed ? Capacity and demand analysis of oncology was planned

     thDate of next meeting 19 April 2007 at CSB, UHCW.

    Y:QNewsletter/January March 2007 Page 8 of 11

    thstUser Group Last meetings held on 10 and 21 March 2007

    ? The user groups across the Network have experienced a busy

    start to 2007 with many projects coming on board required a

    high level of user involvement.

    ? The first of these is the Network Patient Diary which has

    required a tremendous amount of work in both establishing

    what core information should be contained within the diary and

    deciding on fundraising events to help pay for the diary. The

    Make a Difference group have been heavily involved with this

    project and have organised our first fundraising event which is

    a coffee/cake morning at the Arden Cancer Centre, UHCW, thtaking place on 5 April, starting at 10.00 am.

     An Easter Raffle is also being planned to take place on that

     day.

    ? Close links formed with The Shakespeare Hospice. A st„networking‟ event on 1 June will be held at the Hospice,

    which will be jointly hosted by Arden User Group, the Hospice

    and Macmillan. Invitations for this event will despatched shortly

    and a good turnout is looked forward to. ? The Coventry and Warwickshire Group have been asked to

    undertake a patient survey on cancer services across the

    whole Network. This in itself is a huge project and volunteers

    are currently being look for from the user groups to help with

    this task. Completion of the survey is anticipated by June.

    ? The Chair of the Coventry and Warwickshire User Group and

    the Partnerships Facilitator attending the National Development

    Programme in March when the partnership forum discussed

    issued around hospital car parking scheme, supporting patients

    and carers involved with user groups, benefits information and

    a host of other topics.

    ? The Coventry and Warwickshire User Group were delighted to

    welcome two new members to their group, who have already

    lent their support to the coffee morning event.

     stthDates of next meetings 21 April and 9 May 2007

    Imaging No meetings have taken place and a re-launch of this group is

    planned for 24th April 2007. Group

    Y:QNewsletter/January March 2007 Page 9 of 11

    thGP Lead Last meeting held 20 December 2006 at Parkside House.

     Forum

    ? The uncertainty around the future role and funding of the Lead

    Cancer GP still exists. Currently, Val Robson (Coventry PCT)

    and John Bland (North Warwickshire) roles were not affected.

    ? The Network-wide audit of BCC excisions by GPs was widely

    discussed, and concerns around the accreditation of the

    GPwSI role expressed.

    ? New NICE Guidelines for Breast Follow-up Jackie Hatton/

    Angie Arnold had discussions with commissioners but no-one

    was in a position to make a decision. It was agreed that

    following the restructuring of the PCTs, the GP consortia would

    be approached.

    ? 2 Week Wait Referrals and Choose and Book: A workshop

    organised by the PCTs is to be planned. In Coventry, a small

    number of GP surgeries had agreed to be pilots to test the

    system.

     Direct bookable services will be available once the new Trust

     PAS system have been embedded, later in 2007.

     thNext meeting 4 April 2007 at Parkside House.

    South Warks The future of this group is under discussion due to the Warwickshire

    PCT reconfiguration. Locality

    Group

    thLead Nurse Last meeting held 5 February 2007 Parkside House.

     Forum

    ? Nursing Strategy This would be developed in line with the

    new Cancer Reform Strategy.

    ? Members of the LNF have agreed to pilot the new patient diary

    across site-specific groups.

    ? Funding has been secured to provide communication skills

    training 3 x advanced courses for senior nurses are planned

    for 2007. A 1 day communication skills course for frontline staff stis planned for 21 June 2007.

    ? Advanced communication skills courses for doctors will be

    administered centrally by the Cancer Action Team and names

    have been forwarded.

    ? CNS roles and responsibilities across the Network are being

    reviewed within Trusts and PCTs.

    Y:QNewsletter/January March 2007 Page 10 of 11

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