South West Strategic Clinical Network Somerset, Wiltshire, Avon and Gloucestershire (SWAG) Cancer Services. Sponsored by Eli Lilly, Pfizer & Otsuka

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1 Chair: Vidan Masani Meeting of the Lung Site Specific Group (SSG) Tuesday 11 th November 2014 The Orchard Room, Holiday Inn, Filton Road, Bristol BS16 1QX 1. Welcome and apologies Notes (To be agreed at the next Lung SSG meeting) Sponsored by Eli Lilly, Pfizer & Otsuka Please see Appendix 1 for attendees and apologies 2. The Stereotactic Ablative Radiotherapy (SABR) service Please see the uploaded presentation on the SWSCN website Presentation by Charles Comins (CC) The SABR service provides an alternative treatment option for inoperable lung cancer tumours. The tumour classification and site have to meet specific criteria for the treatment to be recommended; therefore it is only appropriate for a small number of patients. SABR is considered the gold standard treatment for inoperable lung cancer. Research results have shown that it can potentially improve overall survival rate from 20 percent to 40 percent. The image guided radiotherapy compensates for tumour motion and ensures the treatment is focused directly at the tumour site. This reduces exposure of radiotherapy to healthy tissue and subsequently reduces treatment related toxicities. Three Linear Accelerator machines and 4 Dimensional Computerised Tomography scanners capable of providing this treatment will soon be available for use at University Hospitals Bristol NHS Foundation Trust. One is in situ at present. In order to be eligible for the treatment, a patient must be able to lie flat and still for 45 minutes. Twenty patients have been treated out of the 25 that have been referred so far. The treatment usually requires seven hospital visits. Although it is more time consuming, it has been found to be far more tolerable than conventional radiotherapy, and is comparable to surgical intervention when considering the impact on a patient s quality of life. The SABR service is not currently funded by the commissioning groups; therefore there are insufficient resources to take referrals from the Peninsula at present. MDTs across the SWAG cancer services are to be encouraged to consider referring patients for SABR when reviewing patients for a lung wedge resection for whom surgery would present a considerable risk. MDT core members

2 Charles Comins will look into developing a referral form to facilitate the referral process. CC 3. Survivorship and Prehabilitation Please see the uploaded presentation on the SWSCN Website Presentation by Catherine Neck and Eveline Internullo The presentation on the Survivorship Programme introduced the possibility of rethinking the current follow up systems that are in place, and establishing new methods of assisting patients living with and beyond cancer. The group was invited to contact Catherine Neck if they require any help to map follow-up pathways relating to this. The presentation also introduced the Prehabilitation project. This potential service development would aim to provide health and wellbeing advice to patients earlier than the current norm, ideally at the point of diagnosis. This is being trialled in University Hospitals Bristol in the Upper GI and gynae-ovarian services. Eveline Internullo provided further evidence of the benefits of prehabilitation, presenting data on three studies which indicated that the provision of preoperative pulmonary rehabilitation, nutritional optimisation, smoking cessation and patient education reduced post-operative pulmonary complications and readmissions. Discussion took place about how to provide exercise programmes when there are limited resources. Walking for fitness groups that are already established were recommended, as was tapping into existing resources. It was concluded that generic guidance of all relevant existing services should be available in the hospital clinics and for GPs to provide to patients. CNS s 4. Management of Brain Metastases Presented by Adam Dangoor Two case studies involving the management of inoperable brain metastases were discussed that highlighted the requirement to have a degree of flexibility to adapt treatment regimens based on individual patients responses to the treatments. It was noted that insufficient patient numbers were recruited to the Quartz Trial to answer the research question of whether optimal supportive care alone is as effective as optimal supportive care plus whole brain radiotherapy (WBRT). This means that there is currently no conclusive evidence to suggest when not treating with WBRT might be the correct decision to make. An audit to look at the treatments and outcomes of patients with inoperable brain

3 metastases over the last three years is to be completed. To be confirmed It was also noted that an MRI of the brain should routinely be offered prior to radical lung cancer surgery in accordance with the latest European guidelines. 5. Network Business Meeting 5a. Notes of last meeting and matters arising Notes were not compiled from the last meeting due to a lack of administrative support. 5b. Network update The SSG Support Manager, Helen Dunderdale (HD), and SSG Support Administrator, Samantha Larsen (SL), are now in post. Their posts will be funded for one year by the South West Strategic Clinical Network. Funding for the posts after this year will be provided by the acute Trusts, with the cost of the SSG service divided based on Trust size (calculated from numbers of cancer treatments), plus the number of SSGs within the region in which each Trust would be participating. This has been agreed by all Trusts. Gloucestershire is now included in the network. They will be joining the SSGs where the patient referral pathways gravitate South. They have been invited to the lung SSG meeting, but with insufficient notice to attend this time. Any operational issues that are identified within the SSG meetings will be escalated to the Cancer Operational Group, and any funding issues will be escalated to the commissioning groups via the South West Strategic Network Cancer Manager, Jonathan Miller. Commercial sponsorship will continue to be sought to assist with funding venues and refreshments for the SSG meetings. The network peer review documentation requires updating. The SSG support team have just been granted access to add content to the South West Strategic Clinical Network website: 2/ Once notes and actions have been uploaded, the link will be ed to the group. There will also be sections added where it will be possible to upload GP referral information, other clinical information and patient and public information. SSG members are to inform HD if they have any content that would be beneficial to upload to the website. HD / SL

4 5c. Thoracic surgery update Please see the uploaded presentation on the SWSCN website Presented by Eveline Internullo. The presentation raised discussion about patient pathway delays affecting achievement of the 62 day target. This was attributed to the increasing number of referrals, delays in radiological scanning and reporting, plus the number of operations cancelled due to University Hospitals Bristol High Dependency Unit s (HDU) bed capacity. It was noted that if a decision to allocate a patient an HDU bed was made in pre-operative clinic, this could not be overturned, as it would be based on an assessment of patients comorbidities. The need for timely discharge of patients from HDU back to the wards was highlighted. It was noted that a research trial to randomise patients to either have a thoracotomy or a VATs lobectomy (50/50) was due to open in eight months, but that currently, 70 percent of patients were referred for VATS lobectomy. 5d. User Representative Update User representatives Joe Norman and Olive Esposito are both happy to remain members of the Lung SSG. They are both affiliated with support groups, so ideally positioned to bring the voice of many patients or carers experiences to the group. At the SWAG user representative group meeting on 25/09/2014, it was unanimously decided that the group would no longer be convened in its current format. A proposal to recommend that the group reconvenes to sit with providers and commissioners is currently being drafted. The groups have agreed that Helen Dunderdale can remain in electronic contact in the meantime, and will also look into recruiting further representatives. 5e. Research update Please see the uploaded presentation on the SWSCN website The Clinical Research Networks (CRN) now aligns with the Academic Health Science Networks. This does not exactly match the old Avon Somerset and Wiltshire SSG. However, the Cancer Research Delivery Managers in both regions, Maxine Taylor (MT) for the West of England CRN, and Wendy Cook (WC) for the South West Peninsula CRN, will continue to support the meeting by providing the data for all Trusts. The West of England Network now consists of Gloucester, Swindon, Bristol, Bath and Weston. Taunton and Yeovil are in South West Peninsula CRN. MT will attend each SSG meeting. Wendy Cook is also to be invited to attend the next Lung SSG. HD

5 Adam Dangoor (AD) is the nominated lead for research for the lung SSG. AD emphasised the importance of cross referring patients to clinical trials if a trial is open in one hospital but not another. Now that patients awareness of clinical trials has increased, people are generally more willing to travel for treatment if this means they will be recruited into a trial. A list of relevant trials has recently been sent to all of the SSG members. A process for communicating research updates outside of the SSG meetings will be established. A surgeon and oncologist from each Trust in the SSG will be identified and sent two-three monthly updates of trials that are open or in set-up. A list of commercial clinical trials to which group members can make an expression of interest will also be circulated. AD It was recommended that the clinical trial STOMP should be opened in all Trusts as it may be challenging to get sufficient recruitment to answer the research question. Uploading information to the SWSCN website regarding clinical trials that are open in each Trust is to be investigated. HD/AD 5F. Trust Audit Presentations SSG members from Taunton and UH Bristol are to present an audit relating to a service improvement at the next SSG meeting. 6. Any other business SSG members from each speciality are to find two speakers that they would like to present at the next SSG meetings. All 7. Date of next meeting The next meeting will be held in the Holiday Inn, Filton on the 19 th May 2015.

6 APPENDIX 1 LUNG ATTENDANCE & APOLOGIES Name Position Trust Present Adam Dangoor Consultant Medical Oncologist University Hospitals Bristol NHS Yes Ashley Cox Consultant Medical Oncologist Royal United Hospital Bath NHS Yes Carrie Trott Lung MDT Co-ordinator University Hospitals Bristol NHS Yes Catherine Neck Macmillan AHP & Survivorship Lead MacMillan, Avon, Somerset & Yes Wiltshire Region Charles Comins Consultant Clinical Oncologist University Hospitals Bristol NHS Yes Claire Parker Consultant Physician of Respiratory Yeovil District Hospital NHS Yes Ed Nicolle Cancer Service Manager Royal United Hospital Bath NHS Yes Eunice Eggleton Lung Cancer Clinical Nurse Specialist Royal United Hospital Bath NHS Yes Eveline Internullo Consultant Thoracic Surgeon University Hospitals Bristol NHS Yes Helen Dunderdale Cancer Network SSG Support South West Strategic Clinical Yes Manager Network (SWSCN) Jenny Davies Lung Cancer Clinical Nurse Specialist Taunton and Somerset NHS Yes Jo Summerill Lung Cancer Support Nurse Taunton and Somerset NHS Yes Joe Norman User Representative Yes Julie Walther Consultant Clinical Oncologist Taunton and Somerset NHS Yes Laura Nicholl Lung Cancer Clinical Nurse Specialist University Hospitals Bristol NHS Yes Lois Phillips Thoracic Clinical Nurse Specialist University Hospitals Bristol NHS Lorraine Keepin Thoracic Clinical Nurse Specialist University Hospitals Bristol NHS Yes Martin Plummeridge Consultant Respiratory North Bristol NHS Trust (NBT) Yes Maxine Taylor Senior Research Delivery Manager / Clinical Research Network - Yes Organisational Development Lead West of England Niki Panakis Consultant Clinical Oncologist Oxford University Hospital Yes Olive Esposito User Representative Yes

7 Samantha Larsen Cancer Network SSG Support South West Strategic Clinical Yes Administrator Network (SWSCN) Sarah Foster Consultant Physician of Respiratory Taunton and Somerset NHS Yes Simon Rose Consultant Histopathologist Royal United Hospital Bath NHS Yes Sophie Fox Lung Cancer Clinical Nurse Specialist University Hospitals Bristol NHS Yes Vidan Masani Consultant Physician of Respiratory Royal United Hospital Bath NHS Yes Abiramy Jeyabalan Lung Cancer Clinical Nurse Specialist University Hospitals Bristol NHS Apologies Andrew Medford Consultant & Honorary Senior North Bristol NHS Trust (NBT) Apologies Lecturer in Thoracic Caroline Fitzavon MDT Co-ordinator Taunton and Somerset NHS Apologies Charlotte Garland Lung Cancer Clinical Nurse Specialist Yeovil District Hospital NHS Apologies Colette Reid Consultant in Palliative University Hospitals Bristol NHS Apologies Edwin Cooper Consultant Histopathologist Yeovil District Hospital NHS Apologies Margaret Blagbrough Physiotherapist Royal United Hospital Bath NHS Apologies Mark Cobby Consultant Radiologist North Bristol NHS Trust (NBT) Apologies Matthew Sephton Consultant Medical Oncologist Yeovil District Hospital NHS Andrew Heryet Laboratory Manager Cellular North Bristol NHS Trust (NBT) Pathology Ann Millar Professor in Respiratory North Bristol Trust (NBT) Apologies Adriana Gjini Consultant in Public Health: Screening and Immunisation Lead PHE / NHS England University Hospitals Bristol NHS Christine Tomkins MDT Co-ordinator Yeovil District Hospital NHS David Farrugia Consultant Medical Oncologist Gloucestershire Hospitals NHS Foundation Trust Denise Leighton-Price Lung Cancer Clinical Nurse Specialist Weston Area Health NHS Trust Edwin Cooper Consultant Histopathologist Yeovil District Hospital NHS

8 Fay Colvin Occupational Therapist University Hospitals Bristol NHS Fiona Young Lung Cancer Clinical Nurse Specialist Gloucestershire Hospitals NHS Foundation Trust Gianluca Casali Consultant Thoracic Surgeon University Hospitals Bristol NHS Janis Angell MDT Data Support North Bristol Trust (NBT) John Hughes Consultant Radiologist University Hospitals Bristol NHS Joya Pawade Consultant Histopathologist University Hospitals Bristol NHS Judith Harvey Lung MDT Co-ordinator Weston Area Health NHS Trust Ladli Chandratreya Consultant Radiologist North Bristol Trust (NBT) Michael Darby Consultant Radiologist North Bristol Trust (NBT) Mohammed Sohail Consultant Histopathologist University Hospitals Bristol NHS Nathan Brasington MDT Team Leader & Data Manager Taunton and Somerset NHS Nicholas Rooney Consultant Histopathologist North Bristol NHS Trust (NBT) Nick Maskell Consultant Physician of Respiratory North Bristol NHS Trust (NBT) Nick Reed Consultant Clinical Oncologist Gloucestershire Hospitals NHS Foundation Trust (GLOS) Nidhi Bhatt Consultant Histopathologist University Hospitals Bristol NHS Paul Craig Consultant Histopathologist Gloucestershire Hospitals NHS Foundation Trust Paula Murphy Consultant Radiologist University Hospitals Bristol NHS Petra Jankowska Consultant Oncologist Yeovil District Hospital NHS Rajendra Sinha Respiratory Secretary Yeovil District Hospital NHS Rajiv Srivastava Consultant Physician of Respiratory Weston Area Health NHS Trust Richard Daly Consultant Histopathologist Weston Area Health NHS Trust Rosalind Goldsmith Colorectal Cancer Clinical Nurse Specialist Royal United Hospital Bath NHS

9 Sarah Smith Lung Cancer and Mesothelioma North Bristol Trust (NBT) Clinical Nurse Specialist Sid Roger Lung Cancer Clinical Nurse Specialist Gloucestershire Hospitals NHS Foundation Trust (GLOS) Stephen Falk Consultant Clinical Oncologist University Hospitals Bristol NHS Stephen Holwill Consultant Histopathologist Taunton and Somerset NHS Susan Adams Consultant Dermatologist Yeovil District Hospital NHS Susan Slater Consultant in Diagnostics Taunton and Somerset NHS Tim Batchelor Consultant Thoracic Surgeon University Hospitals Bristol NHS Tom Wells Consultant Clinical Oncologist Weston Area Health NHS Trust Veronique Poirier NHS England Engagement Programme Manager National Cancer Intelligence Network, Public Health England Yvonne Moul Thoracic Clinical Nurse Specialist Taunton and Somerset NHS