- Email: [email protected]
Streamlining acute oncology referral pathways University Hospitals North Midlands (UHNM)
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Abstracts / Clinical Oncology 28 (2016) S1eS13
3. Sugimura H, Nichols FC, Yang P et al. Survival after recurrent non-small cell lung cancer after complete pulmonary resection. Ann Thorac Surg 2007; 83: 409e417. 4. Lou F, Huang J, Sima CS et al. Patterns of recurrence and second primary lung cancer in early-stage lung cancer survivors followed with routine computed tomography surveillance. J Thorac Cardiovasc Surg 2013; 145: 75e81. 5. Lagerwaard FJ, Aaronson NK, Gundy CM et al. Patient-reported quality of life after stereotactic ablative radiotherapy for early-stage lung cancer. J Thorac Oncol 2012; 7: 1148e1154. 6. Seabag-Montefiore, Crellin A, Turner R et al. A21: 30 and 90 day mortality after 40,670 courses of external beam radiotherapy in unselected patients. National Cancer Research Institute Cancer Conference, Liverpool, 2013.
Streamlining acute oncology referral pathways University Hospitals North Midlands (UHNM) A. Fullagar, A. Jegannathen Oncology, UHNM, Stoke on Trent, United Kingdom
Background to the audit: Emergency Assessment Unit (EAU) is a six bed outpatient assessment unit. The impetus behind the development of EAU was the conclusions drawn from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report.1,2 EAU is a 24-hour advice service using defined criteria to identify patients that would benefit from specialist oncological input. Standard, indicator and target: Timely and effective management of oncological/haematological emergencies by providing direct access to the cancer centre. Act in accordance with national directives to provide urgent specialist treatment to patients receiving systemic anti- cancer treatment; which includes links with the acute oncology service. Manage bed pressures within the cancer centre and thereby reduce pressure on emergency portals. Improve the patient care pathway and access to an expert workforce positively affecting patient experience. Improve patient outcome associated with emergency management of oncology/haematology emergencies. Methodology: Retrospective audit using triage log sheets to identify every referral to EAU. Results of 1st audit round: % of admissions meeting criteria 83 % correctly triaged using phone triage: 90 % discharged within 24 hours: 53 % inappropriate referral referred from within cancer centre: 59 1st action plan: Data highlighted prolonged admissions for ambulatory patients awaiting procedures. New ambulatory pathways were created for venous thromboembolism (VTE), pleural disease and ascities in metastatic ovarian cancer. Results of 2nd audit round: % of admissions meeting criteria: 92 % correctly triaged using phone triage: 98 % discharged within 24 hours: 36 % inappropriate referral referred from within cancer centre: 69 2nd action plan: Clear pathways guide patients to the correct service. Daily senior ward rounds have prevented admission of stable patients. All referrals to EAU from non-clinical staff must now go through the consultant on call. References: 1. National Confidential Enquiry into Patient Outcome and Death. For better, for worse? A review of the care of patients who died within 30 days of receiving systemic anti-cancer therapy. London: National Confidential Enquiry into Patient Outcome and Death, 2008. 2. National Chemotherapy Advisory Group. Chemotherapy services in England: ensuring quality and safety. London: National Chemotherapy Advisory Group, 2009.
An audit of patient outcomes with the SOCCAR chemoradiotherapy regimen for lung cancer at Derriford Hospital, Plymouth P.J. Sankey, A. Roy Oncology, Plymouth Hospitals NHS Trust, Exeter, Devon, United Kingdom
Background to the audit: The ideal chemoradiotherapy regimen for treatment of Stage III lung cancer is not unanimously agreed upon. The sequential or concurrent chemotherapy and radical hypofractionated radiotherapy (SOCCAR) regimen by Maguire et al showed promising results with overall survival (OS) of 70% at one year and 50% at two years.1 Progression free survival (PFS) was 50% at 1 year and local PFS was 74% at one year. Treatment related mortality was 2.9% with G3 oesophagitis of 8.8% Standard, indicator and target: The standard is for overall survival, progression free survival, treatment related mortality and G3 oesophagitis to be comparable to the original SOCCAR data. Methodology: A list of patients who received SOCCAR chemoradiotherapy was obtained by running a report on the aria chemotherapy prescribing system. Medical notes, imaging, blood and histopathology results were reviewed with data collated into an excel spreadsheet. Results of 1st audit round: Seven patients were found with an average age of 63. six patients (35%) had a World Health organization (WHO) performance status of 0 and 11 patients (65%) had a performance status of 1. 11 patients (65%) had stage IIIa disease, five patients (29%) had stage IIIb and one patient had stage IV (oligometastatic bone disease). 13 patients (76%) had neoadjuvant chemotherapy, one patient had adjuvant chemotherapy and the rest had chemoradiotherapy alone. Nine of the 17 patients had completed one year follow-up and in this group there was a one-year OS of 78% and oneyear local and distant PFS of 78%. There were no treatment related deaths and no G3 oesophagitis. 1st action plan: Although the numbers are small the results suggest that our local results are in line with the original SOCCAR data. As the data is in line with expectations no change to current practice is needed. This should be reaudited with extended follow-up. References: 1. Maguire J, Khan I, McMenemin R et al. SOCCAR: A randomised phase II trial comparing sequential versus concurrent chemotherapy and radical hypofractionated radiotherapy in patients with inoperable stage III non-small cell lung cancer and good performance status. Eur J Cancer 2014; 50(17): 2939e2949.
Genetic referral and outcome of patients with colorectal cancer, less than 55 years old, from the North East of Scotland from 2005e2009 K.E. Laurie *, L.M. Samuel y * Edinburgh Royal Infirmary, Edinburgh, United Kingdom y Anchor Unit e Clinic D, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
Background to the audit: Only 10% (in 2011) of patients diagnosed with colorectal cancer (CRC) in Scotland are under 55 years old, who tend to have more advanced disease and tumours more likely to have adverse pathological features.1,2 Scottish Intercollegiate Guidelines Network (SIGN) guidelines suggest a family history (FH) and referral for a genetic analysis, enabling better advice on risks and treatment for patient and tests for relatives. Standard, indicator and target: Contemporary SIGN guidelines from 2003 used as standard for genetic referral targets.3 Methodology: Prospective CRC pathology database from 2005e2009, review of notes and cross referenced with genetic department Shire database. Analysis, using SPSS version 22, in 2015 so five-year follow-up. Results of 1st audit round: 195 patients identified, with 12 excluded as no cancer and 23 as notes not located, so 160 patients included. Age range 22e54, and 50% male/female. Mode of presentation: 13% screening programme, 65% symptomatic clinic, 18% as emergencies and unknown in 4%. A FH documented in 70% of patients and 35% had a FH of CRC. 69 patients (43%) required referral, 20% on age alone, but only 44 patients (65%) were and 31% did not require referral. Shire suggested 95% of genetic information sent to referrer, but no copy in notes in 40%. Survival, according to Dukes stage, similar to that expected from general CRC population. 1st action plan: Standard failed, as only 70% had FH in notes and only 65% were referred to genetics. Feedback given to members of CRC multidisciplinary team (MDT) and genetics team to highlight the need to ensure a) recording of cancer in FH, b) appropriate action taken and c) genetic opinion recorded. Recent policy decision by Scottish NHS to automatically analyse biomarker profile of CRC for any patient less than 50, and not wait for request.
Abstracts / Clinical Oncology 28 (2016) S1eS13
3. Sugimura H, Nichols FC, Yang P et al. Survival after recurrent non-small cell lung cancer after complete pulmonary resection. Ann Thorac Surg 2007; 83: 409e417. 4. Lou F, Huang J, Sima CS et al. Patterns of recurrence and second primary lung cancer in early-stage lung cancer survivors followed with routine computed tomography surveillance. J Thorac Cardiovasc Surg 2013; 145: 75e81. 5. Lagerwaard FJ, Aaronson NK, Gundy CM et al. Patient-reported quality of life after stereotactic ablative radiotherapy for early-stage lung cancer. J Thorac Oncol 2012; 7: 1148e1154. 6. Seabag-Montefiore, Crellin A, Turner R et al. A21: 30 and 90 day mortality after 40,670 courses of external beam radiotherapy in unselected patients. National Cancer Research Institute Cancer Conference, Liverpool, 2013.
Streamlining acute oncology referral pathways University Hospitals North Midlands (UHNM) A. Fullagar, A. Jegannathen Oncology, UHNM, Stoke on Trent, United Kingdom
Background to the audit: Emergency Assessment Unit (EAU) is a six bed outpatient assessment unit. The impetus behind the development of EAU was the conclusions drawn from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report.1,2 EAU is a 24-hour advice service using defined criteria to identify patients that would benefit from specialist oncological input. Standard, indicator and target: Timely and effective management of oncological/haematological emergencies by providing direct access to the cancer centre. Act in accordance with national directives to provide urgent specialist treatment to patients receiving systemic anti- cancer treatment; which includes links with the acute oncology service. Manage bed pressures within the cancer centre and thereby reduce pressure on emergency portals. Improve the patient care pathway and access to an expert workforce positively affecting patient experience. Improve patient outcome associated with emergency management of oncology/haematology emergencies. Methodology: Retrospective audit using triage log sheets to identify every referral to EAU. Results of 1st audit round: % of admissions meeting criteria 83 % correctly triaged using phone triage: 90 % discharged within 24 hours: 53 % inappropriate referral referred from within cancer centre: 59 1st action plan: Data highlighted prolonged admissions for ambulatory patients awaiting procedures. New ambulatory pathways were created for venous thromboembolism (VTE), pleural disease and ascities in metastatic ovarian cancer. Results of 2nd audit round: % of admissions meeting criteria: 92 % correctly triaged using phone triage: 98 % discharged within 24 hours: 36 % inappropriate referral referred from within cancer centre: 69 2nd action plan: Clear pathways guide patients to the correct service. Daily senior ward rounds have prevented admission of stable patients. All referrals to EAU from non-clinical staff must now go through the consultant on call. References: 1. National Confidential Enquiry into Patient Outcome and Death. For better, for worse? A review of the care of patients who died within 30 days of receiving systemic anti-cancer therapy. London: National Confidential Enquiry into Patient Outcome and Death, 2008. 2. National Chemotherapy Advisory Group. Chemotherapy services in England: ensuring quality and safety. London: National Chemotherapy Advisory Group, 2009.
An audit of patient outcomes with the SOCCAR chemoradiotherapy regimen for lung cancer at Derriford Hospital, Plymouth P.J. Sankey, A. Roy Oncology, Plymouth Hospitals NHS Trust, Exeter, Devon, United Kingdom
Background to the audit: The ideal chemoradiotherapy regimen for treatment of Stage III lung cancer is not unanimously agreed upon. The sequential or concurrent chemotherapy and radical hypofractionated radiotherapy (SOCCAR) regimen by Maguire et al showed promising results with overall survival (OS) of 70% at one year and 50% at two years.1 Progression free survival (PFS) was 50% at 1 year and local PFS was 74% at one year. Treatment related mortality was 2.9% with G3 oesophagitis of 8.8% Standard, indicator and target: The standard is for overall survival, progression free survival, treatment related mortality and G3 oesophagitis to be comparable to the original SOCCAR data. Methodology: A list of patients who received SOCCAR chemoradiotherapy was obtained by running a report on the aria chemotherapy prescribing system. Medical notes, imaging, blood and histopathology results were reviewed with data collated into an excel spreadsheet. Results of 1st audit round: Seven patients were found with an average age of 63. six patients (35%) had a World Health organization (WHO) performance status of 0 and 11 patients (65%) had a performance status of 1. 11 patients (65%) had stage IIIa disease, five patients (29%) had stage IIIb and one patient had stage IV (oligometastatic bone disease). 13 patients (76%) had neoadjuvant chemotherapy, one patient had adjuvant chemotherapy and the rest had chemoradiotherapy alone. Nine of the 17 patients had completed one year follow-up and in this group there was a one-year OS of 78% and oneyear local and distant PFS of 78%. There were no treatment related deaths and no G3 oesophagitis. 1st action plan: Although the numbers are small the results suggest that our local results are in line with the original SOCCAR data. As the data is in line with expectations no change to current practice is needed. This should be reaudited with extended follow-up. References: 1. Maguire J, Khan I, McMenemin R et al. SOCCAR: A randomised phase II trial comparing sequential versus concurrent chemotherapy and radical hypofractionated radiotherapy in patients with inoperable stage III non-small cell lung cancer and good performance status. Eur J Cancer 2014; 50(17): 2939e2949.
Genetic referral and outcome of patients with colorectal cancer, less than 55 years old, from the North East of Scotland from 2005e2009 K.E. Laurie *, L.M. Samuel y * Edinburgh Royal Infirmary, Edinburgh, United Kingdom y Anchor Unit e Clinic D, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
Background to the audit: Only 10% (in 2011) of patients diagnosed with colorectal cancer (CRC) in Scotland are under 55 years old, who tend to have more advanced disease and tumours more likely to have adverse pathological features.1,2 Scottish Intercollegiate Guidelines Network (SIGN) guidelines suggest a family history (FH) and referral for a genetic analysis, enabling better advice on risks and treatment for patient and tests for relatives. Standard, indicator and target: Contemporary SIGN guidelines from 2003 used as standard for genetic referral targets.3 Methodology: Prospective CRC pathology database from 2005e2009, review of notes and cross referenced with genetic department Shire database. Analysis, using SPSS version 22, in 2015 so five-year follow-up. Results of 1st audit round: 195 patients identified, with 12 excluded as no cancer and 23 as notes not located, so 160 patients included. Age range 22e54, and 50% male/female. Mode of presentation: 13% screening programme, 65% symptomatic clinic, 18% as emergencies and unknown in 4%. A FH documented in 70% of patients and 35% had a FH of CRC. 69 patients (43%) required referral, 20% on age alone, but only 44 patients (65%) were and 31% did not require referral. Shire suggested 95% of genetic information sent to referrer, but no copy in notes in 40%. Survival, according to Dukes stage, similar to that expected from general CRC population. 1st action plan: Standard failed, as only 70% had FH in notes and only 65% were referred to genetics. Feedback given to members of CRC multidisciplinary team (MDT) and genetics team to highlight the need to ensure a) recording of cancer in FH, b) appropriate action taken and c) genetic opinion recorded. Recent policy decision by Scottish NHS to automatically analyse biomarker profile of CRC for any patient less than 50, and not wait for request.