Upper Gastrointestinal Cancers Regional Conference
Report
23rd March 2005
Templeton Hotel, Templepatrick
9.00am – 1.30pm
Upper GI Regional Conference, 23rd March 2005 NICaN
1 Welcome and Purpose of Conference
In opening the meeting, Dr Gerard Daly, Network Lead Clinician extended a warm welcome to delegates and indicated that the Network Team were delighted to be facilitating this regional conference. Apologies were given for Stuart MacDonnell - Chair of NICaN Board, and the scheduled Conference Chairman, who was unable to attend at short notice. It was indicated that Sandra McKillop, Network Manager and Dr Daly would host the proceedings.
The Conference Speakers, including the keynote speaker Professor Michael Griffin, President of Association of Upper GI Surgeons (AUGIS) and Clinical Director of the Northern Oseophago-Gastric Unit in Newcastle Upon Tyne, were welcomed.
The purpose of the conference was outlined as two fold:
§ To consider the relevant guidance, and the implications of its implementation, in the management of upper GI Cancers in N Ireland;
§ To benefit from the experience of guideline implementation from elsewhere in the UK.
A significant amount of time had been scheduled into the conference programme to maximise the involvement and contribution of delegates.
2 Shaping our Services for the Future
Mr Andrew Hamilton, Deputy Secretary for the Department of Health and Social Services and Public Safety, was welcomed as the first speaker. Mr Hamilton began by indicating that in a climate of increasingly challenging circumstances and the need to continue to provide improved services that are more patient focused, the managed clinical network offers a model to meet these needs. He brought the delegates attention to the Department’s initiative on funding a number of managed clinical networks across the region. Clinical standards and professional regulation were highlighted as influential in network development. The adoption of national (including NICE) guidance within Northern Ireland was indicated as a departmental proposal. Attention was drawn to the establishment of the Health and Social Services Regulation and Inspection Authority (HSSRIA) as of April 2005.
3 What the Patient wants from their Service?
Mr McMullan, stated that he was pleased to have been asked to provide a patients perspective on the service. His key message in his talk was that patients want to be treated by the right people, in the right place and to the highest possible standard of care.
4 Changing Priorities
Mr Williamson highlighted the poor curative resection rates of oesophageal and gastric cancer patients, stating that quality of life was paramount to patients and carers and the need to ensure morbidity was kept to a minimum. He recommended that studies of treatments in patients with incurable upper GI cancer should use validated questionnaires to measure quality of life outcomes and that treatment decisions should clearly take account of co-morbidity and performance status. (A copy of the Presentation is attached.)
5 Keynote Address – Guidance to Practice – the Experience in England
Professor Griffin outlined his experience of setting up an oesophagogastric cancer services within the Newcastle Cancer Network: including the establishment of a Multi-disciplinary Team (MDT) and a Network Tumour Specific Group. Professor Griffin spent some time describing the oesophagogastric cancer services which covers a population of 1.6millio. The achievements of the Network Tumour Specific Group were also outlined, including evidence based practice, patient support, regional planning, agreed staging protocols and a upper GI patient pathway. (A copy of the Presentation is attached.)
6 Practice in Northern Ireland – Cancer Service Audit 1996 -2001
Mrs McKillop welcomed Dr Anna Gavin, Director of the Northern Ireland Cancer Registry. Dr Gavin provided a summary of the Northern Ireland Cancer Registry’s audit on oesophageal and stomach cancers. (Copies of the Report had been provided to all delegates.)
It was stated that this report is one of a series of commissioned reports that will examine in detail the care for patients with cancer in Northern Ireland.
7 Taking Stock and Looking to the Future
Mrs McKillop thanked all presenters for their contributions before stating that the remaining time provided an opportunity for all delegates to consider the information provided and its implications for the future development of a person centred upper GI service in Northern Ireland.
Dr Daly briefly recapped the salient points of the presentations and the values of the Northern Ireland Cancer Network before asking Seamus Carey, Principal Consultant – Beeches Management Centre, to facilitate the group work.
The salient points from the group work session are shown below
Question 1 – What expertise and facilities are required for the ideal direct access endoscopy service?
§ Clear information for GPs about referral
§ Accredited facilities[1] and personnel matching or exceeding national standards.
§ Dedicated point of referral (phone, fax or email) from Primary Care
§ “Same day” results forwarded to Primary Care
§ Pathology reports by a specialist and in a timely manner
§ Common/ integrated/ interconnected data capture
§ Clear information for patients about service and interpretation of results.
Question 2 – What examples of good practice have you in your area for a direct access endsoscopy service?
§ Locally agreed guidelines and proforma for “urgent” referral
§ Capacity to inform local MDT of cancer diagnosis at time of procedure
§ Access for diverse user groups
§ Video capture of abnormal procedure/findings
§ Designated clinician to be responsible for patient with abnormal findings
Question 3 – When a patient is diagnosed with an upper GI cancer who are the right people to whom they need same day access?
§ Someone competent in “Breaking Bad News”
§ Appropriate environment for “Breaking Bad News” – perhaps dedicated outpatient slots
§ Patient support – trained nurses / CNS, able to make further contact on day following diagnosis
§ Information for patients
§ Palliative care access
Question 4 – What examples of good practice can you share with your colleagues?
§ Results clinic. [There is an expectation of appropriate time, appropriate facilities and a competent clinician to convey results.]
§ Team of people who are knowledgeable
§ Integration into agreed clinical pathway (radiology and other slots protected)
§ Integration into agreed multidisciplinary/ multiprofessional team
§ Immediate feedback to GP of diagnosis and patients knowledge
Question 5 – What expertise is required for an effective, local upper GI MDT?
§ Clinical Leadership
§ Meeting/service co-ordinator
§ Data/audit support
§ Endoscopic (diagnostic and therapeutic) skills
§ Pathology expertise
§ Radiological (diagnostic and therapeutic) skills
§ Surgical Skills [ ?visiting, ?onsite or ?via tele link]
§ (anaesthetist ‘ intensivists)
§ Oncolgy [medical and clinical] expertise
§ Palliative care skills*
§ AHP Skills (specifically dietetic*
§ Upper GI Clinical Nurse Specialist
§ [Be inclusive of trainees in appropriate disciplines]
§ [?research]
* These need to be holistic in their approach
Question 6 – What examples of good practice can you share with your colleagues?
§ MDM has specified function
§ MDM is part of programmed activity
§ Co-ordinator
§ Agreed referrals to “central” [regional] MDM
§ Defined “Chair”
§ Macmillan nurse as “key worker” / “point of contact”
§ Access to PET scans
§ Teleconferencing Links
Question 7 – What expertise is required for an effective, regional upper GI cancer MDT?
§ As Question 5
§ Clinical Leadership
§ User Involvement
§ Anaesthetist/ Intensivists
§ Comprehensive Surgical Expertise
§ Specialist Pathology
§ Specialist Oncology
§ Research culture
§ Education culture
§ Specialist diagnostics[ PET; EUS;EUS/FNA]
§ Specialist palliation [laser; photodynamic; brachytherapy]
§ Horizon scanning
§ [Defined Pathway]
Question 8 – How do we take forward the work on the establishment of an upper GI cancer group within the Network?
§ Representation [Opinions varied from democratic to a small core group. However, following Professor Griffin’s intervention, representation from each acute trust is to be sought.]
§ Clinical Leadership
§ Distinguish purpose – oesophagogastric but not pancreatic-hepatobiliary
§ Need for representatives to be allowed time to develop a regional group and regional approach
8 Concluding Remarks
Dr Daly thanked everyone for their contributions to a very productive group work session. Particular thanks were offered to the Chairs and Facilitators at each table.
It was stated that this was the start of a journey to consider the management of upper GI cancers in Northern Ireland, and to ensure momentum it was proposed that a regional group for the management of upper GI cancers be established. This is inline with the development of NICaN and the establishment of other tumour and theme groups. It is envisaged that this group would be the principal source of advice to planners, commissioners and providers of services to indicate the service reconfiguration, and resource implications, required to achieve the highest quality of patient care.
As there was unanimous agreement that a NICaN upper GI regional group needed to be established Mr Carey asked for Professor Griffin’s and Mr Williamson’s thoughts on the way forward, based on their own experience. Professor Griffin recommended that a regional group be created before moving towards a regional MDT. He acknowledged that large groups can be unmanageable but in his opinion wide representation was required – he outlined that the first Newcastle Cancer Network Regional Group had 35 attendees, although this was now approximately 24. He suggested that the group have representatives from all hospitals, all specialisms needed represented and that the focus should be on gastric cancer.
Mr Williamson added that the WoSCAN upper GI group had been existence for three years and outlined that it had representatives of all of the five board areas as well as all specialisms involved, in order that the core group held validity with the Health Executive. The group also had patient representatives which was described as a positive but sobering experience.
As to the next steps it was suggested and agreed that Dr Daly as the Lead Clinician of the Network explores and develop a mechanism for seeking nominations to the regional group.
The actions from the meeting were summarised as follows:
1. Produce report of meeting / NICaN Team2. Process for seeking nominations to an upper GI regional group to be explored. / Dr Daly & NICaN Team
3. Inaugural meeting of upper GI regional meeting to be arranged once membership is secured. / NICaN Team
Dr Daly closed the conference by thanking all speakers and the delegates for participating before inviting everyone to stay for lunch and networking opportunities.
APPENDIX I
ATTENDEES
First Name / Last Name / Job Title / OrganisationElaine / Ardis / Senior Dietician / Craigavon Area Hospital
Yvonne / Byrne / Sister / Royal Group of Hospitals
Paula / Calahan / Royal Group of Hospitals
Sally / Campalani / Directorate Nurse Haem & Onc / Belfast City Hospital
Prof Frederick / Campbell / Professor Dept of Surgery / Royal Group of Hospitals
Mr Declan / Carey / Surgeon / Belfast City Hospital
Margaret / Carlin / Macmillan Nurse / Mid Ulster Hospital
Dr James / Clarke / Consultant Radiologist / NI PET Institute
Mr Barry / Clements / Surgeon / Royal Group of Hospitals
Louise / Collins / Macmillan Upper GI Nurse / Royal Group of Hospitals
Mary Ann / Conlon / Macmillan CNS / CHSST
Dr Diane / Corrigan / Consultant in Public Health Medicine / SHSSB
Dr Alan / Cromie / United Hospital Trust
Dr Gerard / Daly / Network Lead Clinician / NICaN
Dr Dermott / Davison / Network Lead GP / NICaN
Eileen / Deery / Lead Nurse / United Hospital Trust
Dr Yvonne / Duff / Palliative Care Consultant / NHSSB
Dr Martin / Eatock / Medical Oncologist / Belfast City Hospital
Dr Peter / Ellis / Radiologist / Royal Group of Hospitals
Elizabeth / England / Lead Cancer Nurse / Altnagelvin Hospital
Sarah-Jayne / Faloon / Senior Oncology Dietician / Belfast City Hospital
Dr Kieran / Fitzpatrick / Belfast City Hospital
Shelagh / Fleming / Dietician / Ulster Comm & Hospitals Trust
Dr Anna / Gavin / Director / NICR
Dr Michael / Gibbons / Craigavon Area Hospital
Kathy / Goumas / SIF / Service Improvement Unit
Fionnuala / Green / Regional Pharmacy Co-ordinator / Belfast City Hospital
Prof Michael / Griffin / President / AUGIS
Mr Andrew / Hamilton / Deputy Secretary / DHSSPSNI
Dr Tim / Harding / Consultant Physician / Lagan Valley Hospital
Mr John / Hughes / Biostatistican / NI Cancer Registry
Dr Neil / Jackson / Cons in Palliative Medicine / Royal Group & NI Hospice
Prof Peter / Jarritt / Director / NI Medical Physics Agency
Rachel / Jennings / Genetics Counsellor / Belfast City Hospital
Dr Brian / Johnston / Royal Group of Hospitals
Prof Frank / Kee / Epidemiology & Public Health / NHSSB
Dr Don / Keegan / Chair / RACC
Mr Andrew / Kennedy / Surgeon / Royal Group of Hospitals
Heather / Kinnear / Biostatistican / NI Cancer Research
Claire / Kirk / Genetics Counsellor / Belfast City Hospital
Mr Jack / Lee / Belfast City Hospital
Lesley / Leeman / SIF / Service Improvement Unit
Antoinette / Lenfestey / Macmillan Nurse / Mater Hospital Trust
Janet / Little / EHSSB
Dr Maurice / Loughrey / Royal Group of Hospitals
Dr Mark / Love / Consultant Radiologist / Royal Group of Hospitals
Beth / Malloy / Planning Manager / Belfast City Hospital
Stewart / Massey / Member / Oesophageal Patients Ass
Patricia / McBride / Social Worker / N&W Belfast Trust
Pamela / McCartney / Clinical Audit Facilitator for Cancer Services / Craigavon Area Hospital
Maire / McGrady / Regional Pharmacy Co-ordinator / Belfast City Hospital
Mr Jim / McGuigan / Lead Clinician / Royal Group of Hospitals
Mr Lloyd / McKie / Consultant Surgeon / Mater Hospital Trust
Sandra / McKillop / Network Manager / NICaN
Ann / McLean / Lead Nurse / Royal Group of Hospitals
Roy / McMullen / Chair / Oesophageal Patients Ass
Lisa / McWilliams / Network Administrator / NICaN
Moyra / Mills / Research Assistant / QUB
Dr Michael / Mitchell / Belfast City Hospital
Mr Damien / Mole / Research Fellow & SPR / QUB
Mr John / Moorehead / Surgeon / Ulster Comm & Hospitals Trust
Mr Fred / Mullan / Consultant Surgeon / Causeway Trust
Hazel / Neill / Lead Nurse / Craigavon Area Hospital
Dr Frank / O'Connor / Medical & AMB Consultant / Altnagelvin Hospital
Bridget / O'Neill / Ward Sister / Royal Group of Hospitals
Chukwuemeka / Ozo / Consultant / United Hospital Trust
Alison / Porter / Lead Nurse / Ulster Comm & Hospitals Trust
Patricia / Sheppard / Directorate Manager for Surgery / Belfast City Hospital
Prof Roy / Spence / Lead Clinician / Belfast City Hospital
Dr Tony / Tham / Consultant Gastroenterologist / Ulster Comm & Hospitals Trust
Dr Abraham / Varghese / Causeway Trust
Rosemary / Ward / QUB
John / Watson / Director of Public Health / NHSSB
Mr Peter / Watson / Consultant Gastroenterologist / Royal Group of Hospitals
Nuala / Wilkinson / Staff Nurse - Day Procedure / Mid Ulster Hospital
Mr Barry / Williamson / Lead Upper GI Clinician / WOSCAN
Apologies
Mr Ray / Hannon / Director of Surgery / Belfast City Hospital
Dr Dermot / Hughes / Lead Cancer Clinician / Altnagelvin Hospital
Dr Bill / McConnell / Director of Public Health / WHSSB
Brenda / Ray / Sister Day Procedure Unit / Royal Group of Hospitals
Dr Anne / Wilson / Director of Public Health / EHSSB
APPENDIX II