Quarterly Newsletter – March 2007
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.
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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
? 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.
? 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
? 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
thDate of next meeting 25 April 2007
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stGynaecology Last meeting held on 31 January 2007 at Warwick Hospital.
? 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
? 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
? 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.
? 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
thThe date of the next meeting Thursday 8 March 2007.
thHead & Last meeting held on 18 January 2007 at UHCW.
? It was noted that a joint peer review will be held for UHCW and
Heartlands. An action plan will be developed and discussed at
? 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
? 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
? 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
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.
? 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
? 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
? 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
? 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.
? Herceptin policy amended as per NICE guidelines revision Group
? Network chemotherapy Strategy discussed and amendments
? Sue Marsh reviewed compliance with NICE Technology
? Chemotherapy guidelines being developed across all tumour
? 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
? 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
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thGP Lead Last meeting held 20 December 2006 at Parkside House.
? 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
? 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
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
thLead Nurse Last meeting held 5 February 2007 Parkside House.
? 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.
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