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57 Effectiveness of decision making at lung cancer multidisciplinary team meetings
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Posters, 9th Annual BTOG Conference, 2011: Networks & Pathways
was performed using Kaplan Meier curves to compare PTEN expression with survival. Results: Mesothelial cells in normal pleura demonstrated positive staining for PTEN protein and served as a positive reference. For tumour samples the expression of PTEN was scored as 0 (negative), 1 (intensity less than that of normal pleura positive reference slide) and 2 (intensity equal to or greater than that of normal pleura). PTEN expression score was 0 in 26% (23/86), 1 in 26% (23/86) and 2 in 46% (40/86). Survival data were available for all 86 patients. Univariate analysis demonstrated that loss of PTEN was not associated with survival (p = 0.223). Conclusion: We have demonstrated that PTEN is lost in 26% of patients with MPM. However, loss of PTEN was not found to be of prognostic significance. Loss of PTEN may result activation of the PI3K/AKT/MTOR pathway, hence targeting this pathway with inhibitors further downstream of PTEN may provide a potential therapeutic target.
Networks & Pathways 57 Effectiveness of decision making at lung cancer multidisciplinary team meetings W. Storrar, D. Laws. Department of Thoracic Medicine, Royal Bournemouth Hospital, Bournemouth, Dorset, United Kingdom Aim: To investigate whether the agreed treatment plan following a lung cancer multidisciplinary team (MDT) meeting correlates with the actual treatment that a patient receives. Method: This study was conducted at a District General Hospital in Bournemouth, Dorset with a catchment area of 400,000 and 220 new diagnoses of lung cancer per year. 100 consecutive cases discussed at the Lung Cancer MDT were identified. Patient demographics, cancer subtype, staging, performance status and final recommendation made at MDT were documented. The actual treatment that a patient received was confirmed. If management differed from the initial treatment plan, the reason for this was recorded. Results: There was a change in treatment plan after the MDT in 16% of cases. In 69% of these cases the change in treatment plan was a result of patient choice. In 94% of the cases the change in treatment plan was from active treatment to a more conservative approach. 49% of patients had active anti-cancer treatment. Discussion: The most common reason for a change in management plan was patient choice. Less commonly the change in management plan was due to deterioration in performance status between initial assessment and follow up appointment. The MDT is expected to recommend best treatment options for each individual and prior knowledge of a patient’s case including performance status and co-morbidities is essential. In our hospital Performance Status is documented in 92% of cases. Patient choice is important too however and it is therefore correct that there be the facility for patients to choose not to have active treatment. The MDT would not be expected to know the patient’s preference for this. The LUCADA audit recommends MDTs review their practice if anticancer treatment is less than the average 54%. We propose that this statement does not take into account patient’s preference. 58 SCAN Lung Group a patient satisfaction survey D. Borthwick, F. Little. Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland, United Kingdom Introduction: Patient satisfaction is now deemed an important outcome measure for health services and increasingly emphasis is being put on how services are being delivered at local level. The focus of this survey was to get a broad overview of patients thoughts on the lung cancer service within the South-East Scotland Cancer
Network (SCAN) and to facilitate any improvement in the quality of care provided to meet their needs better. Methods: A questionnaire was identified which had been used in a similar population and we adapted it accordingly. The format and questions were adjusted to explore areas of care at the time of diagnosis, during treatment and in the follow-up period. The survey contained a mixture of qualitative and quantitative components with room for free text was conducted across SCAN consisting of the Edinburgh Cancer Centre and outlying clinics in Borders, Fife and Dumfries & Galloway. New patients, patients on surgical follow-up and those currently on treatment were excluded. The questionnaires were completed by patients attending oncology clinics during November 2009 and were distributed by the receptionists or clinic staff and completed prior to seeing their oncologist. Results: Two hundred and sixty-two patients attended for followup across SCAN and one hundred and seventy-three patients returned completed questionniares, a response of 66%. The main issues included communication of diagnosis by junior doctors, underestimation of toxicities of treatment by oncologists and inadequate information and support on coping following treatment. Some patients felt support from their GP at diagnosis and on follow-up was lacking. Most patients expressed a lack of interest in attending support groups. Conclusion: Whilst the vast majority of patients expressed satisfaction with all aspects of the service, our survey highlighted areas that could be improved. Action plans have been developed by each region to improve the services in areas identified. 59 A joint non medical prescribing clinic for the management of patients requiring tyrosine kinase inhibitors and chemotherapy treatments led by a lung cancer clinical nurse specialist and a Macmillan pharmacist E.M. Bowden, N. Horne. Llandough Hospital, Cardiff, Wales, United Kingdom Introduction/Background: Within the local Lung Cancer Service the Clinical Oncologist receives in excess of 200 new patient referrals annually for consideration of chemotherapeutic treatments. Specialist Registrar cover is not available for the treatment clinic and therefore the workload for the Consultant is significant. Routinely individual patient clinic waits are excessively long. Both the Pharmacist and one of the Lung Cancer Clinical Nurse Specialists (CNS) have undergone Non Medical Prescribing (NMP) training. The aim of the project is to explore a different way of working to reduce the lengthy clinic waits currently experienced by lung cancer patients in an Oncology Clinic in South Wales. Methods: Run a three month pilot study to audit the quality and content of the NMP consultations versus the standard medical consultation. Use an adapted NMP protocol, agreed clinical management plans and patient satisfaction questionnaire. Utilise and develop the combined advanced skills of the Lung Cancer CNS and Pharmacist. Results: The pilot will end at the beginning of February 2011 but the preliminary results of the Patient Satisfaction questionnaires to date suggest overwhelmingly that this is an acceptable approach from the patient and carer perspective. It also confirms that for some patients the timeliness of the consultation enhances a positive experience of the Lung Cancer Team as a whole. Conclusions: The implications for practice locally will be demonstrated at BTOG in January 2012 once our results have been analysed.
Posters, 9th Annual BTOG Conference, 2011: Networks & Pathways
was performed using Kaplan Meier curves to compare PTEN expression with survival. Results: Mesothelial cells in normal pleura demonstrated positive staining for PTEN protein and served as a positive reference. For tumour samples the expression of PTEN was scored as 0 (negative), 1 (intensity less than that of normal pleura positive reference slide) and 2 (intensity equal to or greater than that of normal pleura). PTEN expression score was 0 in 26% (23/86), 1 in 26% (23/86) and 2 in 46% (40/86). Survival data were available for all 86 patients. Univariate analysis demonstrated that loss of PTEN was not associated with survival (p = 0.223). Conclusion: We have demonstrated that PTEN is lost in 26% of patients with MPM. However, loss of PTEN was not found to be of prognostic significance. Loss of PTEN may result activation of the PI3K/AKT/MTOR pathway, hence targeting this pathway with inhibitors further downstream of PTEN may provide a potential therapeutic target.
Networks & Pathways 57 Effectiveness of decision making at lung cancer multidisciplinary team meetings W. Storrar, D. Laws. Department of Thoracic Medicine, Royal Bournemouth Hospital, Bournemouth, Dorset, United Kingdom Aim: To investigate whether the agreed treatment plan following a lung cancer multidisciplinary team (MDT) meeting correlates with the actual treatment that a patient receives. Method: This study was conducted at a District General Hospital in Bournemouth, Dorset with a catchment area of 400,000 and 220 new diagnoses of lung cancer per year. 100 consecutive cases discussed at the Lung Cancer MDT were identified. Patient demographics, cancer subtype, staging, performance status and final recommendation made at MDT were documented. The actual treatment that a patient received was confirmed. If management differed from the initial treatment plan, the reason for this was recorded. Results: There was a change in treatment plan after the MDT in 16% of cases. In 69% of these cases the change in treatment plan was a result of patient choice. In 94% of the cases the change in treatment plan was from active treatment to a more conservative approach. 49% of patients had active anti-cancer treatment. Discussion: The most common reason for a change in management plan was patient choice. Less commonly the change in management plan was due to deterioration in performance status between initial assessment and follow up appointment. The MDT is expected to recommend best treatment options for each individual and prior knowledge of a patient’s case including performance status and co-morbidities is essential. In our hospital Performance Status is documented in 92% of cases. Patient choice is important too however and it is therefore correct that there be the facility for patients to choose not to have active treatment. The MDT would not be expected to know the patient’s preference for this. The LUCADA audit recommends MDTs review their practice if anticancer treatment is less than the average 54%. We propose that this statement does not take into account patient’s preference. 58 SCAN Lung Group a patient satisfaction survey D. Borthwick, F. Little. Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland, United Kingdom Introduction: Patient satisfaction is now deemed an important outcome measure for health services and increasingly emphasis is being put on how services are being delivered at local level. The focus of this survey was to get a broad overview of patients thoughts on the lung cancer service within the South-East Scotland Cancer
Network (SCAN) and to facilitate any improvement in the quality of care provided to meet their needs better. Methods: A questionnaire was identified which had been used in a similar population and we adapted it accordingly. The format and questions were adjusted to explore areas of care at the time of diagnosis, during treatment and in the follow-up period. The survey contained a mixture of qualitative and quantitative components with room for free text was conducted across SCAN consisting of the Edinburgh Cancer Centre and outlying clinics in Borders, Fife and Dumfries & Galloway. New patients, patients on surgical follow-up and those currently on treatment were excluded. The questionnaires were completed by patients attending oncology clinics during November 2009 and were distributed by the receptionists or clinic staff and completed prior to seeing their oncologist. Results: Two hundred and sixty-two patients attended for followup across SCAN and one hundred and seventy-three patients returned completed questionniares, a response of 66%. The main issues included communication of diagnosis by junior doctors, underestimation of toxicities of treatment by oncologists and inadequate information and support on coping following treatment. Some patients felt support from their GP at diagnosis and on follow-up was lacking. Most patients expressed a lack of interest in attending support groups. Conclusion: Whilst the vast majority of patients expressed satisfaction with all aspects of the service, our survey highlighted areas that could be improved. Action plans have been developed by each region to improve the services in areas identified. 59 A joint non medical prescribing clinic for the management of patients requiring tyrosine kinase inhibitors and chemotherapy treatments led by a lung cancer clinical nurse specialist and a Macmillan pharmacist E.M. Bowden, N. Horne. Llandough Hospital, Cardiff, Wales, United Kingdom Introduction/Background: Within the local Lung Cancer Service the Clinical Oncologist receives in excess of 200 new patient referrals annually for consideration of chemotherapeutic treatments. Specialist Registrar cover is not available for the treatment clinic and therefore the workload for the Consultant is significant. Routinely individual patient clinic waits are excessively long. Both the Pharmacist and one of the Lung Cancer Clinical Nurse Specialists (CNS) have undergone Non Medical Prescribing (NMP) training. The aim of the project is to explore a different way of working to reduce the lengthy clinic waits currently experienced by lung cancer patients in an Oncology Clinic in South Wales. Methods: Run a three month pilot study to audit the quality and content of the NMP consultations versus the standard medical consultation. Use an adapted NMP protocol, agreed clinical management plans and patient satisfaction questionnaire. Utilise and develop the combined advanced skills of the Lung Cancer CNS and Pharmacist. Results: The pilot will end at the beginning of February 2011 but the preliminary results of the Patient Satisfaction questionnaires to date suggest overwhelmingly that this is an acceptable approach from the patient and carer perspective. It also confirms that for some patients the timeliness of the consultation enhances a positive experience of the Lung Cancer Team as a whole. Conclusions: The implications for practice locally will be demonstrated at BTOG in January 2012 once our results have been analysed.