Renal Cancer Pathway Network Meeting

Monday 1st August 2013

17.30 – 18.30pm

Hubworking, 5 Wormwood Street, London, EC2M 1RQ

Action
1. / Apologies ( see Appendix 1)
2 / Introduction and Agenda – Tom Powles (chair)
Oncology pathway
Communicaion and Information requirements
3 / Oncology Guidelines
TP presented a set of 3 slides representing the proposed guidelines which had been discussed and agreed with Dr Boletti, Oncology lead, RFL:
·  Commencing first line therapy in fit patients with metastatic / advanced renal cancer
·  Sequencing of systemic therapy
·  The role of nephrectomy in metastatic disease – it was noted that nephrectomy was only generally indicated for patients with good MSKCC risk, and should be clinically driven for all other risk groups. GS commented that if the primary was symptomatic then nephrectomy should be considered – this was agreed and to be added to the guidelines
TP stated that the guidelines had been seen and discussed by oncologists in both NC and NE London and it was possible to revise them at any stage and should be revised as required by new evidence going forward.
The guidelines were therefore agreed at the meeting, with the addition as discussed above, and to be circulated to Pathway members with the minutes. / GA to amend slide before circulation
4. / Communications and Information Requirements
GS presented a draft patient journey indicating the information outputs that would be provided by RFL to the referring hospitals using the example of a patient referred for specialist surgery for discussion.
Information requirements from the referring hospital to the SMDT and SMDT clinic. These were listed as :
1.  Referral ( this can be a simple one line letter)
2.  All previous correspondence
3.  Imaging
4.  Inter-Trust transfer form
NiR reported that it was not usual to provide the Inter-Trust referral form until it had been confirmed at the SMDT that the patient would be seen in the SMDT clinic. This was because other specialties can refer directly to the SMDT.
AL asked that a template form be sent to her at BHRUT so that her trust could start to use a similar form to ensure the same details would be available to the NE London SMDT.
MDT proforma: It was noted that the outcome for each patient from the SMDT ( the SMDT proforma) was emailed out to the referring hospitals including CNSs after the meeting by the RFL SMDT Co-ordinator. This is currently on the Monday lunchtime following the Friday meeting. There followed discussion and agreement that each hospital should now have a generic email nhs.net address to receive this information. The information could be emailed to other recipients as requested but the local hospital should ensure that the generic address was the one that was used to react in a timely way to the information provided.
NiR informed the group that clinic dates and times were normally not provided with this information but within a short time period following the email. It was noted that the SMDT co-ordinator requires the CNS to acknowledge that the patient has been informed of the SMDT decision before the appointment is sent to the patient.
Incidental findings: discussion followed on how and whose responsibility it was to communicate with the patient with a confirmed renal cancer requiring treatment at the specialist centre following the SMDT decision. The CNSs in the meeting felt that they would be the ideal role to communicate with these patients and that they as a group could agree a structured approach to informing these patients. They were better equipped to inform patients than other members of the team and to ensure that patients were aware of the outcome and the need to attend clinic to discuss their treatment options as soon as possible, avoiding the need to book an appointment in their local hospital and possible delaying treatment.
GS felt that this should be discussed more widely at the next meeting in September scheduled to agree the diagnostic pathway, and it requires a mechanism in the Pathway for identifying such patients. AL commented that such a point in the pathway would allow specific intervention for CNS – currently there is no identified point compared to other urological cancers.
SMDT clinic: GS stated that after the SMDT clinic a clinic letter should be sent to a generic account in the referring hospital, as above for the MDT outcome proforma. It was agreed that this should happen within 5 working days.
GW asked if RFL sends a copy letter to the patient. He commented that this is done at BCF and works well. LG informed the meeting that this is also the default position at RFL via DictateIT. There followed discussion on the need for remote access to speed up the approval process. LG agreed to set this up for the SMDT consultants.
Patient booked for surgery: On discharge home post-surgery, an email will be sent to the generic email address of the referring hospital on the same day or the following Monday. It was agreed that a dictated operation note was not required at this stage.
There followed discussion about the variability in quality of the discharge summary and the need for improvement. GW suggested that at some future point consultants would be able to do this.
First follow up: It was agreed that the same information was required as for the SMDT clinic and should be available within 5 working days.
GS provided some examples of the Renal Cancer patient tracker and informed the meeting that dedicated admin support had been assigned to this task. An updated patient tracker will now go to all referring hospitals on Friday afternoon to the generic email – as above, and to any requested recipients.
AL asked if this information could go to Somerset, BHRUT’s cancer information system. GS responded that the information may be also be on Infoflex but was not sure how to access the information. There was some discussion on its usefulness and the need to avoid duplication.
AL also stated that the CNS network needed to be strengthened as this would benefit patients in terms of seamless handover. / NiR to AL
GA to add to agenda
LG
GS/GA to amend diagram
5 / AOB
·  GW felt it was important to know patient’s renal function and identified renal impairment for the MDT discussion and following treatment decision. It was therefore necessary to have access to electrolyte reports. It was also imperative to be able to access imaging reports.
GS agreed that the patient’s most recent creatinine level should be on the Inter-trust referral form. AL commented that at BHRUT this information is cut and pasted into the referral document.
·  GW asked for access to Oncology reports for the patient’s follow up appointment. These are currently in a separate drive and hard to access during the OP appointment.
GS reported that this will be available from December 2013. LG reported that an exception could be made for oncology reports to be available sooner and would action this for Tuesday 13.08.2013. NiR noted that she currently brings this information to the SMDT meeting for BCF patients.
·  GW asked about admin support for the SMDT clinic. LG stated that a Renal Cancer co-ordinator would be appointed once the current re-structuring exercise had been completed / LG
6 / Date/Time and Venue of Next Meeting:
Monday 9th September 2013 17.30 – 18.30pm
Hubworking, 5 Wormwood Street, London, EC2M 1RQ

Future meetings are as follows:

Monday 7th October / 5.30 – 6.30pm
Thursday 7th November / 5.30 – 6.30pm
Monday 9th December / 5.30 – 6.30pm

All at Hubworking, 5 Wormwood Street, London, EC2M 1RQ