SCAN Breast Group Friday 2 May 2014 14.00 – 16.00 Breast Unit Seminar Room Western General Hospital Edinburgh Minutes Present Glyn Neades Wilma Jack Vince Kerr Kate Macdonald Stella Macpherson Emma Childs Christine Dodds Val Doherty Roisin Bradley Marlene Malloch Sharon Cowel-Smith Ahmed Khalil Shelley-Marie O’Hare Carole Smith Ashwini Sharma Consultant Surgeon, WGH, QMH (Chair) Senior Clinical Research Fellow, WGH SCAN Breast Group Administrator SCAN Network Manager Patient Representative Clinical Nurse Practitioner, EBU SCAN Senior Cancer Audit Facilitator, WGH Chair SCAN Consultant Radiologist, EBU Breast Care Nurse, QMH Research Nurse, WGH Consultant Surgeon, BGH Clinical Nurse Practitioner, EBU Patient Representative Consultant Radiologist, EBU/QMH Via VC from DGRI Martin Keith Cancer Improvement Manager, DGRI Apologies Maggie McHardy Susan Jamieson Elaine Anderson Frances Yuille Carolyn Bedi Tamasin Evans Clare Gorman Nicola Bargeton Lorna Bruce Lynn Paul Angela Bowman Audit Facilitator, NHS Fife Breast Care Nurse, NHS Fife Clinical Director, Breast Services, Breast Screening & Plastics, NHS Lothian Cons Clinical Oncologist, NHS Lothian Cons Clinical Oncologist, NHS Lothian/BGH Cons Clinical Oncologist, NHS Lothian/DGRI Service Manager, NHS Lothian Cons Radiologist, NHS Fife Audit Manager, SCAN Breast Care Nurse, EBU Cons Medical Oncologist, NHS Lothian 1 Item Action 1 The minutes of the last SCAN Breast Group meeting held on 21 March 2013 were accepted as being a true record of that meeting. Matters Arising The St John's Hospital One Stop Breast Clinic should be in full operation in September once the remaining Radiology issues are resolved. 2 Adjuvant Endocrine Treatment Guidelines – Sign Off Emma Childs informed the meeting that following discussions with the other Scottish Breast Cancer networks, agreement has been reached to adopt the guidelines nationally after examination of the Risks and Benefits. The use of online risk management systems such as Adjuvant on Line is advocated. Larry Hayward has agreed to produce a Patient Information Leaflet. LH Action – Larry Hayward With this in mind it was agreed to adopt the latest version (Appendix A) which will be circulated to the other Scottish Cancer Networks and within SCAN. Once this is complete the document is to be lodged on the OOQS website. Action – Emma Childs EC In addition the document will be reviewed in 1 year during which time prospective data will be collected and reported back to this meeting at that time Action – Emma Childs EC 3 National Breast QPI Report The Report first shown at the Scottish Breast Cancer Audit Meeting in November last year has now been finalised and a narrative added. It is available to view here: (http://www.isdscotland.org/Health-Topics/Quality-Indicators/Cancer-QPI/) It was noted that as we are currently collecting data for the 3rd year of QPIs, if any changes are proposed to the QPIs then it needs to be accomplished soon. We have been told that Iona Scott is organising a meeting to discus this. 4 Scottish Breast Cancer Trials Meeting The New Chair, Iain MacPherson has been in touch and has indicated that the Trials Group have expressed a preference to hold their meeting in the first quarter of the year. This is to take time pressure away from clinical colleagues during the very busy final quarter and to benefit from the knowledge gleaned from the international meetings held at the end of the year. The Trials Group have convened a meeting on 8 May and have this matter on their agenda, so we will be better placed to think about the way forward after this. (The proposal was accepted) There is merit in moving the Audit meeting to the first quarter in that any anomalies thrown up by the ISD analysis will be able to be addressed by the time of the meeting and an explanation discussed. Pharma are more likely to sponsor a 2 day meeting than 2 one day meetings. Chair to review the GTN situation in the light of the Trials meeting outcome & take appropriate action. 5 Borders Surgery – Staffing Update Ahmed Khalil brought the meeting up to date with the staffing situation at BGH John O'Neill has retired and although John Rainey has retired he has come back to undertake a 1 year Locum Breast Surgery position. Ben Ward is covering Breast Radiology at BGH and has some sessions at WGH. This enables Symptomatic Wire Guided Excisions by ultrasound only (Stereos still come to EBU) and Sentinel Node biopsy is underway. Ahmed Khalil is reviewing the MDM documentation and clinic set-up. Christine Dodds was asked if it is possible to determine the number of localisations done in EBU for CD BGH and if so to report this information to the meeting. If screening cases are to be operated on in BGH (1.5-2 per week), then screening localisation problems with PACs availability and documentation will have to be resolved. There will also need to be a discussion between the surgeon and radiologist prior to the surgery. Meantime Ahmed Khalil can operate on BGH screening cases in Edinburgh but will need to have an Honorary Contract with NHS Lothian. It should also be noted that QA demands a minimum number of screening localisation surgical procedures to be completed annually. 2 6 Sentinel Node Biopsy Update Updates were given from the various areas. Fife: Radio isotope delivery continues to be a minor problem. With one delivery daily all SNBx procedures must be complete by 1430. An afternoon delivery would allow these procedures to be undertaken throughout the day. However the present schedule works well, for the moment. Martin Keith reported from DGRI that Crosshouse Hospital hold the ARSAC license though this is not yet completely signed off. (Expected Aug-Sep. MK to get update from Maria Bews-Hair which he will circulate) . GTN informed the meeting that at a meeting in Glasgow there was a report that iron particles have been used in Spain, France & Italy rather than radioisotope though this is no more cost effective but has good concordance rates. 7 Radiology QMH – Repatriation of screening patients: It was generally agreed that the peripheral units should aim to be taking their own screening patients. The are a number of issues to be addressed , Timing and participation at Screening MDM’s, QA for Pathology & Radiology, documentation and coordinated working between surgeon & radiologist around localisations. Family History – MRI enough slots in Edinburgh New cases will go to Family History in Edinburgh, identify BRCA 1 & 2 already in the system (already looked at whole region including Fife) Riosin Bradley to check with Janet Clarke RB Tuesday Clinic to be split into am & pm sections Radiographers – Currently 3. One is retiring. One could possibly take early retirement We need to identify funding for a training course which takes 12 – 18 months There is a possibility that the Job Description could change resulting in a loss of pay under Agenda for Change rules. WGH - Another Radiologist post will be established at the end of September and this will enable the Breast Radiology Team to support the St Johns One Stop Clinic. Large Core Biopsy. The first patient will be seen soon, the service is set up using strict guidelines. As experience accumulates these may be expanded. 8 9 Patient Pathways and Reprovision Kate Macdonald informed us that there is a need to review Patient Pathways to guide the planning of the new Edinburgh Cancer Centre which will be built on the site of the current DCN. The pathways will need to consider emergence evidence and ongoing trial to inform potential accommodation needs in 510 years and will be fed in to a subgroup chaired by Tracy Gillies. The pathway should include a draft regional patient pathway taking into account that many D & G patients will probably prefer to travel to the recently announced “Lanarkshire Beatson” to be opened at Monklands General Hospital in Airdrie in 2017. Wilma Jack is to send Kate Macdonald pathway information presently held by Breast. WJ Kate Macdonald will report progress back to the Group. KM 10 SCAN Update Radiotherapy Cancer Planning. A SCAN SLWG is in the process of undertaking detailed capacity planning using cancer incidence and population projection figures from ISD. Additional linac capacity will be required to maintain the service but how much has yet to be confirmed as this depends on workforce capacity, shift patterns, and linac utilisation. QPI For future Audit meetings, QPI data should be processed by ISD for early November and the report thus produced should have the outliers explained prior to the annual Scottish audit meeting in February, comment and narrative added after the meeting and the final report published as soon as possible thereafter. 3 11 12 Chemotherapy Chemotherapy CEL Audit – All SCAN boards are required to participate in cross regional audit for the SACT CEL, which commences in June in Borders. One of the issues identified by the board self assessments against the CEL completed in September 2013 is who will undertake the role of clinical lead for chemotherapy. In anticipation and preparing for the audit NHS Borders Nurse Consultant requested a copy of the Glasgow clinical lead job description in order to develop a job description for NHS Borders Chemotherapy Clinical lead. Chemo care. Kate Macdonald informed the meeting that this system is being rolled out across the SCAN region. This will give details of outcomes, housekeeping reports, activity reports and an end of treatment summary. PACs/PACE Individual Patient Treatment Requests give patients and clinicians the opportunity to access non SMC approved medicines. Each Individual Patient Treatment Request is based on individual clinical status. SGHD has announced a change in this process to a Peer Approved Clinical System. Details of the revised process are yet to be announced by SGHD but in the interim boards are to continue with the existing IPTR process until notified otherwise. 13 PACE is a new stage to the Scottish Medicines Consortium (SMC) assessment process. It can be used to allow a more flexible approach to considering medicines for either end of life treatment or very rare conditions (called orphan, orphan equivalent or ultra orphan medicines). The main part of the PACE process is a meeting which brings together patient representatives and healthcare professional experts. The purpose of the PACE meeting is to gather detailed information which will allow a discussion on the benefits of a medicine, including how it can impact the quality of a patient’s life. This information may not always be fully captured within the conventional assessment process. Further details at this link (www.scottishmedicines.org.uk/About_SMC/Latest_News/News_Articles/SMC_Submission_to _the_Health_and_Sport_Committee) 14 Any Other Business Audit Christine outlined a current project in which the audit data for 2011 is being matched to Cancer Registry data for the same period in order to investigate reasons for any patients failing to be identified for audit. It is hoped that all colleagues in SCAN will participate so that a full picture can be reported. So far only a very small number of patients have been identified who have been missed, but a full report will be provided at a later date. Action CD & audit colleagues CD Detect Cancer Early The new campaign will be a “low level” campaign aimed at encouraging improved take up of breast screening invitations which are particularly poorly attended by patients from deprived areas. This, it was felt should not have the same impact on Breast services generated by the last campaign which led to a significant increase in referrals. Screening. The National Patient Information Leaflet on Breast Screening is inadequate and needs to be rewritten. Next Meeting The next meeting of the SCAN Breast Group will be held in the Breast Unit Seminar Room at a date and time to be confirmed 4