ST GEORGE'S HOSPITAL (TOOTING) Report Guide

Team Results

Overall Compliance

93.3%
Self Assessment
Up from 90% Self Assessment in 2012-2013 cycle

National Benchmark Position

Serious Concerns
and Immediate Risks

No serious concern or immediate risk was identified when the service was last assessed

The Service has a complete team

Members cover all relevant disciplines.

Trust Results

2013 National Cancer Patient Experience Survey Results for Trust

Involved in treatment decisions68%
Given name of CNS in charge86%
Confidence and trust in doctors83%
Post discharge contact information90%
Hospital and community staff teamwork58%

Waiting Times for Trust All Cancer Services April - June 2013

Treated in targeted time
2 Weeks 97%
31 Days 97%
62 Days 85%

Structure and Function of the Service

Mr Thomas Ind currently holds the role of local MDT lead. All key workers are in place including both medical and clinical oncologist (Fiona Lofts and Susan Lalondrelle); centre sub-specialist surgeons (Des Barton & Thomas Ind); unit surgeons (Paul Carter, Paul Bulmer, Kevin Hayes and Kamal Ojah); a radiologist (Susan Heenan) and a clinical nurse specialist (Anna Castellano who is back from maternity leave). We currently have a locum in place providing histopathology services and a substantive appointment is soon to be advertised.

The core membership includes;

Mr Desmond Barton (centre gynaecological oncology surgeon)

Mr Paul Bulmer (gynaecologist – unit & diagnostics)

Mr Paul Carter (gynaecologists – unit & TWR lead)

Mr Kevin Hayes (gynaecologist – diagnostics & unit)

Dr Susan Heenan (radiologist)

Mr Thomas Ind (centre & unit gynaecological oncology surgeon – MDT lead)

Dr Susan Lalondrelle (clinical oncologist)

Locum (histopathologist)

Dr Fiona Lofts (medical oncologist)

Sr Anna Castellano (clinical nurse specialist)

Mr Kamal Ojah (gynaecologist – diagnostics & unit)

Attendance to MDT by core and peripheral members is audited and recorded. This was last audited in October 2012 and all core members met the 75% attendance standard.

The operational policy and workload plan is reviewed annually and a meeting took place on Monday 30th September 2013.

For the year ending 31st March 2013, the department complied with both the day 14 and day 31 waiting standards. Having failed to meet the 62 day standard last time we achieved 100% compliance this year. In particular, efforts have been made to reduce the time taken to transfer patients between peripheral units and St George’s.

The results of the waiting time audit are listed below;

14 Day Standard Target 93% Year end figure 94.3%

31 Day Standard Target 96% Year end figure 98.6%

62 Day Standard Target 85% Year end figure 100.0%

The numbers of patients with cancer treated in the joint cancer centre and unit were analysed during a departmental options appraisal in 2011/2012. There were on average 12 – 15 patients discussed per MDT of which at least 4 – 5 were new patients with a suspected cancer diagnosis. This means that there are over 600 patient discussions at the St George’s MDT on an annual basis. Patients can be discussed more than once and in the previous year there were a total of 323 patients discussed.

We asked the department of histopathology to quantify the number of cases of Gynaecological cancer treated surgically over the year 2011/2012. We also asked them for an analysis as to which tumours were low grade and stage (e.g. unit activity) and which were of a higher stage and grade (e.g. centre activity).

The activity was as follows;

Tumour Type

Ovary Fallopian Tube Uterus Cervix Vagina Vulva All

Unit 8 0 31 10 0 0 49

Centre 33 1 45 4 5 3 91

Total

41 1 76 14 5 3 140

The total unit activity of histologically proven cancer cases was a total of 49. To gauge the work performed by the diagnostic component of the unit, a previous audit of Two Week Rule referrals identified that there were a total of 11 referrals for every histologically proven cancer case.

How many patients by equality characteristic were diagnosed / treated in the previous year?

Gynae 105

A - British 43

B - Irish 1

C - Any other White background 8

H - Indian 2

J - Pakistani 3

L - Any other Asian background 7

M - Caribbean 3

N - African 2

P - Any other Black background 5

R - Chinese 1

S - Any other ethnic group 7

Z - Not stated 23

Coordination of Care/Patient Pathway

St George’s Hospital is part of a joint cancer centre with the Royal Marsden Hospital Fulham and Royal Marsden Hospital Sutton. The cancer centre provides sub-specialty gynaecological oncology services to the populations served by St George’s Hospital, Chelsea and Westminster Hospital, Croydon University Hospital, St Helier’s Hospital, Epsom Hospital, and Kingston Hospital. The centre also provides a gynaecological cancer centre service to the island of Jersey and rock of Gibraltar.

St George’s Hospital joint cancer centre and unit also provides a cancer unit service to the population of Tooting. The specific unit services offered include Two Week Rule clinics, pelvic mass clinics, post-menopausal bleeding clinics, out-patient hysteroscopy clinics, rapid access clinics, and colposcopy clinics.

A protocol exists for the colposcopy clinic that has had it’s own QA visit recently.

Network guidelines exist for the management of all gynaecological cancers and these are updated regularly.

A local MDT occurs on a weekly basis and once a month this is immediately followed by a joint gynaecological oncology clinic attended by the surgical, clinical, and medical oncologists as well as the clinical nurse specialist. Decisions are recorded on the hospital base intranet and are available electronically. The centre MDT occurs via a video link with connections at St George’s Hospital, Royal Marsden Fulham (where chaired), Royal Marsden Sutton, and Croydon. All new cancer cases are discussed at the centre MDT and St George’s Hospital records these decisions electronically.

There is an additional monthly colposcopy MDT.

Patient Experience

Results of two audits have given insight into this

National Cancer Patient Experience Programme

The report of the National Cancer Patient Experience Programme 2012 was published on 30th August 2013. In our survey results this year the number of respondents were less than 20. This unfortunately means there is no available data in the tables broken down by tumour type. This is often the case with rarer tumours.

The table below has been updated to demonstrate the achievements from last year’s action plan

Table 1:

Recommendation Actions required Person responsible Action taken

1. Improve explanation in relation to purpose of the test and what would be involved during the test. Evaluate the current practice on information relating to ‘Tests’ and identify areas for improvement. Team Worked with radiology departments within the Trust to be involved in developing updated ‘patient information’.

2. Improve explanation of what was wrong with patient so that they completely understand.

To review how treatment explanations are offered to patients and look at how this information could be delivered in an understandable way. Team Reviewed how patients are offered information. CNS goes through ‘core Information pack’ with patient and asks patient at next appointment if patient wishes to go through any information within the pack again.

3. To ensure that inappropriate patient information is not left on patient’s answer machine. Discuss with administrative staff involved in contacting patients. Develop agreed guidelines on information which may be left on a patient’s answer machine. Medical and surgical consultants. Trust policy now adopted when administrative staff are involved in discussing any information with patients.

As part of an agreed CQUIN with commissioners all newly diagnosed cervix patients at St George’s will take part in a survey this financial year. The results of which will be available after next March. The survey is being undertaken to identify if by having a CNS their patient experience is improved. (Previous surveys and evidence suggest having a CNS does make a difference).

Colposcopy patient satisfaction survey

A patient satisfaction survey was performed for the colposcopy clinic. The results of this survey were good and were recognised during the recent QA visit.

Individual clinicians

All individual clinicians are participating in 360 degree appraisals including feedback from patients and professional staff.

Clinical Outcomes

From our 2011/2012 review a total of 91 patients underwent major resections. This figure reflects the fact that St George’s Hospital acts a joint cancer centre and cancer unit. The distribution of these cases is given in the Structure and Function section of this document.

During this time period, we are unaware of any 30 day peri-operative mortality.

Patients during this period have been recruited to CHORUS and UKFOCSS which are now closed. Patients are also being recruited to MEOC, ICON6, PETROC and ICON 8. In a previous year, 23 patients were recruited to clinical trials.

Surgical complications are audited. There is a monthly morbidity meeting where individual major complications are discussed.

The results of the patient satisfaction audits are given in the section above.

There is a monthly colposcopy audit. In particular, the number of treatments of less than 7mm and number with positive margins are audited. These cases are discussed on an individual basis.

Good Practice

The department adheres to all national guidelines and IOG guidelines.

Since last year a clinical information system (Infoflex) has been installed by the trust and has been utilised during the multidisciplinary team meetings. Full staging information during this period has been achieved in 93% of cases.

The department receives a number of tertiary referrals from within the network but also from further afield. Mr Barton receives tertiary referrals for exenterative surgery and Mr Ind for trachelectomy. Both surgeons have regular visitors from other institutions.

All consultants are active participants in their respective professional societies. Mr Barton is a member of council of the British Gynaecological Cancer Society. Mr Ind is Treasurer of the BSGE and Treasurer of the BIARGS. All members of the colposcopy team hold valid in-date BSCCP/RCOG certificates.

The out-patient hysteroscopy clinic has been an extremely successful service that has assisted prompt diagnosis and reduced the need for general anaesthetic in a group of women with high co-morbidity.

A trans-vaginal ultrasound service lead by Kevin Hayes is run within the department of gynaecology and provides prompt diagnostic services allowing one-stop experiences for many of our patients.

The colposcopy service lead by Paul Carter is large and well respected. It was praised at a recent QA visit. Mr Thomas Ind and Sr Marianne Wood are also registered by the BSCCP as trainers as well as colposcopists.

The department has a fellow in gynaecological oncology and

The core members of the MDT remain active in clinical research and have 17 new publications listed on PubMed since last year. These are listed below;

1: Barton DP, Adib T, Butler J. Surgical practice of UK gynaecological

oncologists in the treatment of primary advanced epithelial ovarian cancer

(PAEOC): A questionnaire survey. Gynecol Oncol. 2013 Aug 13. doi:pii:

S0090-8258(13)01085-8. 10.1016/j.ygyno.2013.08.007. [Epub ahead of print] PubMed PMID: 23954901.

2: McDonald F, Lalondrelle S, Taylor H, Warren-Oseni K, Khoo V, McNair HA, Harris

V, Hafeez S, Hansen VN, Thomas K, Jones K, Dearnaley D, Horwich A, Huddart R.

Clinical implementation of adaptive hypofractionated bladder radiotherapy for

improvement in normal tissue irradiation. Clin Oncol (R Coll Radiol). 2013

Sep;25(9):549-56. doi: 10.1016/j.clon.2013.06.001. Epub 2013 Jul 21. PubMed PMID:

23880296.

3: Downey K, Jafar M, Attygalle AD, Hazell S, Morgan VA, Giles SL, Schmidt MA,

Ind TE, Shepherd JH, deSouza NM. Influencing surgical management in patients with

carcinoma of the cervix using a T2- and ZOOM-diffusion-weighted endovaginal MRI

technique. Br J Cancer. 2013 Aug 6;109(3):615-22. doi: 10.1038/bjc.2013.375. Epub

2013 Jul 18. PubMed PMID: 23868012; PubMed Central PMCID: PMC3738120.

4: Brockbank EC, Harry V, Kolomainen D, Mukhopadhyay D, Sohaib A, Bridges JE,

Nobbenhuis MA, Shepherd JH, Ind TE, Barton DP. Laparoscopic staging for apparent

early stage ovarian or fallopian tube cancer. First case series from a UK cancer

centre and systematic literature review. Eur J Surg Oncol. 2013 Aug;39(8):912-7.

doi: 10.1016/j.ejso.2013.05.007. Epub 2013 May 27. Review. PubMed PMID: 23721765.

5: Kaushik S, Akhter K, Rufford B, Ind TE, Kolomainen DF, Butler J, Barton DP.

The use of laparostomy in patients with gynecologic cancer: first report from a

UK cancer center. Int J Gynecol Cancer. 2013 Jun;23(5):951-5. doi:

10.1097/IGC.0b013e31829169fc. PubMed PMID: 23571659.

6: Downey K, Riches SF, Morgan VA, Giles SL, Attygalle AD, Ind TE, Barton DP,

Shepherd JH, deSouza NM. Relationship between imaging biomarkers of stage I

cervical cancer and poor-prognosis histologic features: quantitative histogram

analysis of diffusion-weighted MR images. AJR Am J Roentgenol. 2013

Feb;200(2):314-20. doi: 10.2214/AJR.12.9545. PubMed PMID: 23345352.

7: Lam W, Alnajjar HM, La-Touche S, Perry M, Sharma D, Corbishley C, Pilcher J,

Heenan S, Watkin N. Dynamic sentinel lymph node biopsy in patients with invasive

squamous cell carcinoma of the penis: a prospective study of the long-term

outcome of 500 inguinal basins assessed at a single institution. Eur Urol. 2013

Apr;63(4):657-63. doi: 10.1016/j.eururo.2012.10.035. Epub 2012 Oct 27. PubMed

PMID: 23153743.

8: Nobbenhuis MA, Balasubramani L, Kolomainen DF, Barton DP. Surgical management and follow-up of patients with cervical cancer: survey of gynaecological

oncologists in the UK. J Obstet Gynaecol. 2012 Aug;32(6):576-9. doi:

10.3109/01443615.2012.694510. PubMed PMID: 22779966.

9: Roy A, Cunningham D, Hawkins R, Sörbye H, Adenis A, Barcelo JR, Lopez-Vivanco

G, Adler G, Canon JL, Lofts F, Castanon C, Fonseca E, Rixe O, Aparicio J,

Cassinello J, Nicolson M, Mousseau M, Schalhorn A, D'Hondt L, Kerger J, Hossfeld

DK, Garcia Giron C, Rodriguez R, Schoffski P, Misset JL. Docetaxel combined with

irinotecan or 5-fluorouracil in patients with advanced oesophago-gastric cancer:

a randomised phase II study. Br J Cancer. 2012 Jul 24;107(3):435-41. doi:

10.1038/bjc.2012.286. Epub 2012 Jul 5. PubMed PMID: 22767144; PubMed Central

PMCID: PMC3405223.

10: Vitfell-Pedersen J, Yap TA, Moreno V, Baird RD, Khan AZ, Barton DP, Kaye SB.

The role of surgery in patients with advanced gynaecological cancers

participating in phase I clinical trials. Eur J Gynaecol Oncol. 2012;33(2):211-3.

PubMed PMID: 22611966.

11: Raza SA, Sohaib SA, Sahdev A, Bharwani N, Heenan S, Verma H, Patel U.

Centrally infiltrating renal masses on CT: differentiating intrarenal

transitional cell carcinoma from centrally located renal cell carcinoma. AJR Am J

Roentgenol. 2012 Apr;198(4):846-53. doi: 10.2214/AJR.11.7376. PubMed PMID:

22451550.

12: Good J, Lalondrelle S, Blake P. Point: Parametrial irradiation in locally

advanced cervix cancer can be achieved effectively with a variety of external

beam techniques. Brachytherapy. 2012 Mar-Apr;11(2):77-9; discussion 85-6. doi:

10.1016/j.brachy.2012.01.003. PubMed PMID: 22390920.

13: Brady A, Nayar A, Cross P, Patel A, Naik R, Lee S, Kaushik S, Barton D,

McCluggage WG. A detailed immunohistochemical analysis of 2 cases of papillary

cystadenoma of the broad ligament: an extremely rare neoplasm characteristic of

patients with von hippel-lindau disease. Int J Gynecol Pathol. 2012

Mar;31(2):133-40. doi: 10.1097/PGP.0b013e318228f577. PubMed PMID: 22317868.

14: Lalondrelle S, Sohaib SA, Castellano IA, Mears D, Huddart R, Khoo V.

Investigating the relationship between virtual cystoscopy image quality and CT

slice thickness. Br J Radiol. 2012 Aug;85(1016):1112-7. doi:

10.1259/bjr/99567374. Epub 2012 Jan 3. PubMed PMID: 22215882; PubMed Central

PMCID: PMC3587099.

15: Nobbenhuis MA, Bancroft E, Moskovic E, Lennard F, Pharoah P, Jacobs I, Ward

A, Barton DP, Ind TE, Shepherd JH, Bridges JE, Gore M, Haracopos C, Shanley S,

Ardern-Jones A, Thomas S, Eeles R. Screening for ovarian cancer in women with

varying levels of risk, using annual tests, results in high recall for repeat

screening tests. Hered Cancer Clin Pract. 2011 Nov 23;9(1):11. doi:

10.1186/1897-4287-9-11. PubMed PMID: 22112691; PubMed Central PMCID: PMC3231989.

16: Maraveyas A, Waters J, Roy R, Fyfe D, Propper D, Lofts F, Sgouros J, Gardiner

E, Wedgwood K, Ettelaie C, Bozas G. Gemcitabine versus gemcitabine plus

dalteparin thromboprophylaxis in pancreatic cancer. Eur J Cancer. 2012

Jun;48(9):1283-92. doi: 10.1016/j.ejca.2011.10.017. Epub 2011 Nov 17. PubMed

PMID: 22100906.

17: Kolomainen DF, Daponte A, Barton DP, Pennert K, Ind TE, Bridges JE, Shepherd

JH, Gore ME, Kaye SB, Riley J. Outcomes of surgical management of bowel

obstruction in relapsed epithelial ovarian cancer (EOC). Gynecol Oncol. 2012

Apr;125(1):31-6. doi: 10.1016/j.ygyno.2011.11.007. Epub 2011 Nov 12. PubMed PMID: 22082991.

Immediate Risks

No Immediate Risk was identified

Serious Concerns

No Serious Concern was identified

Concerns

None

General Comments

Social media
Follow us on Twitter Join us on facebook
National Peer Review Programme © 2013