Leading ladies - The Royal Marsden
Transcription
Leading ladies - The Royal Marsden
Private care ISSUE 9 EQUIPPED FOR EXCELLENCE High-tech scanning in our diagnostic imaging suites DIAGNOSIS AND CARE Patient support from our urology experts Leading ladies Meet the women at the forefront of research at The Royal Marsden Issue 9 CONTENTS PRIVATE CARE FEATURES Welcome In this issue of Private Care, we take an in-depth look at the diagnostic imaging units at both our Chelsea and Sutton hospitals. Our multi-million-pound investment in the units ensures that the hospital has the latest in MRI and PET/CT scanners. This means we can now scan more private patients more efficiently and in more comfortable surroundings. In addition, the equipment allows us to expand the scope of clinical trials to help develop new treatment options. Also, Mr Pardeep Kumar, Consultant Urological Surgeon, discusses the signs and symptoms of urological cancers. The Royal Marsden’s new Private Care Rapid Diagnostic and Assessment service includes a one-stop, new patient assessment clinic for these cancers. Finally, we are pleased to introduce our two Private Care Clinical Nurse Specialists Gwynedd Burgoyne and Suzy Halliday, who are an integral part of the Breast Unit team at both Chelsea and Sutton. We hope you enjoy reading the updates and news in this issue of Private Care. Mr Satvinder Mudan, Divisional Medical Director Louise McNamara, Divisional Nurse Director 2 The Royal Marsden Private Care 6. WOMEN IN RESEARCH We meet three women making valuable contributions to research at The Royal Marsden 8. INVESTMENT IN DIAGNOSTIC IMAGING Our new MRI and PET/CT scanners are set to boost patient treatment and trials 10. UROLOGICAL CANCERS Q&A Consultant Urological Surgeon Mr Pardeep Kumar outlines the symptoms of urological cancers and how they are diagnosed 11. STAFF FOCUS Clinical Nurse Specialists Gwynedd Burgoyne and Suzy Halliday explain their role in guiding and supporting breast cancer patients from diagnosis through to treatment PRIVATE CARE NEWS 3. UPDATE New technology to treat ovarian cancer; Critical Care Unit’s key values; prostate cancer drug’s UK approval; GP Education Days; paediatric CyberKnife treatment Front cover photograph: Dr Susana Banerjee, Consultant Medical Oncologist, Gynaecology Unit Hospital news UPDATE Surgeons Mr John Butler, Mr Des Barton and Ms Marielle Nobbenhuis using the PlasmaJet New technology to tackle ovarian cancer The Royal Marsden is one of the first UK centres to use a new high-energy surgical device for women with advanced ovarian cancer. Introduced at the hospital by Mr Des Barton, Consultant Gynaecological Surgeon, the PlasmaJet device uses the plasma energy from ionised argon gas to cut through and dissect tissue, stop bleeding and destroy cancer cells safely. Unlike most other energy devices used in surgery, it can destroy cells on the surface of organs and tissue with minimal collateral effect. In particular, the PlasmaJet has applications in advanced ovarian cancer, where the disease is typically in multiple nodules or ‘sheets’ on the surface of organs and tissue in the abdomen and pelvis. After a trial period at The Royal Marsden to assess its applicability, safety and efficacy in ovarian cancer, it is now an essential part of the hospital’s surgical apparatus. Ms Marielle Nobbenhuis, Honorary Consultant Gynaecological Surgeon, said: “During PlasmaJet surgery, cancer cells are removed from structures such as the bowel and diaphragm, without causing damage to the surrounding tissue. This means there is often no need to resect or remove the tissue in these areas. “Previously, many women undergoing extensive surgery for ovarian cancer had to have parts of their bowel removed in order to eradicate the disease. Extensive removal of bowel tissue can mean that a stoma is required, which has a serious impact on a patient’s quality of life after their surgery and the amount of time they need to spend in hospital afterwards. “There is a clear correlation between the amount of residual visible disease following ovarian cancer surgery and the patient’s survival. With the PlasmaJet, not only can we completely remove or destroy all visible disease, there is less need for bowel resection. This has the most impact on improving the survival time and offers the potential for actually curing these patients.” The Royal Marsden’s experience with the PlasmaJet was presented at an international meeting last year. Ms Nobbenhuis said: “No other surgical device can safely remove and destroy the same amount of cancer cells. At The Royal Marsden, a leading centre for the management of ovarian cancer, we are starting to deliver improved outcomes for patients with advanced disease.” No other surgical device can remove and destroy the same number of cancer cells MS MARIELLE NOBBENHUIS, CONSULTANT GYNAECOLOGICAL SURGEON The Royal Marsden Private Care 3 UPDATE RADIUM-223 PROSTATE DRUG GETS UK APPROVAL A new drug for men with advanced prostate cancer has been given approval for use in the UK, following successful trials at The Royal Marsden. Xofigo (radium-223 dichloride) is now available for the treatment of men with castration-resistant prostate cancer who have symptomatic bone metastases. The announcement follows a positive recommendation from the European Medical Agency’s Committee for Medicinal Products for Human Use. Xofigo has also received marketing authorisation by the European Commission, based on data from the pivotal Phase III ALSYMPCA study – which was stopped early as the drug proved so effective. Dr Chris Parker, Principal Investigator of the ALSYMPCA trial and Consultant Clinical Oncologist at The Royal Marsden, said: “The majority of men who develop castrationresistant prostate cancer will develop bone metastases, which can be painful and even life-threatening. Until now, treatment for bone secondaries has been limited to symptom control, rather than improving survival. The source of radiation, radium-223, acts like calcium and sticks to the bone, targeting the tumours. “This drug enables men to live longer and experience less pain and fewer side effects. Its approval is a huge step forward for prostate cancer patients.” 4 The Royal Marsden Private Care CCU values defined committed to making these values more visible. By looking at how the Trust’s values translate into the care it provides, the Critical Care Unit (CCU) has become one of the first departments at The Royal Marsden to re-evaluate its working culture. A staff consultation led to the identification of four core values that staff members believe are most important For many years, The Royal Marsden has promoted a set of 16 distinct values that define attitudes and behaviours among our staff, in order to ensure that patients receive the best possible treatment and care. Following the publication in February 2013 of the Francis Report, which stressed the importance of putting the patient at the centre of care, the Trust has to them and what they aspire to be: personal, compassionate, supportive and open. “Among ourselves, we are always asking: ‘What can we do better for our patients?’,” said Sister Keetje Gull. “Sometimes feedback isn’t positive, so we need to be open and listen to this, then make changes. It all comes down to the patient experience. Like other areas of the Trust, the CCU is helping patients and their families get through what is often a traumatic and difficult time.” Sister Clare Lucas explained that the values translate to behaviours that underpin our standards. “Part of our recruitment process is to ensure that staff share these nursing values and that they are applied in relations with both patients and staff,” she said. “These values are not new. But we have worked to articulate and redefine them.” Among ourselves, we are always asking: ‘What can we do better for our patients?’ SISTER KEETJE GULL, CRITICAL CARE UNIT THE TRUST’S 16 VALUES What we are Pioneering Aspirational Knowledgeable Driven How we act Determined Confident Open Resilient How we relate to others Collaborative Supportive Trusted Personable How we feel Compassionate Positive Calm Proud Hospital news PAEDIATRIC FIRST FOR CYBERKNIFE GP training at The Royal Marsden GPs play a vital part in their patients’ cancer care, from referral and diagnosis to supporting them through treatment and co-ordinating their follow-up care. The Royal Marsden’s GP Education Series is a programme of events and online learning opportunities that allows us to contribute to GPs’ professional development by sharing some of our expertise and knowledge. Dr Nick Van As, a Consultant Clinical Oncologist who has been involved in the GP Education Series since it began in 2009, said: “GPs are encouraged to ask questions, discuss issues with colleagues and offer their professional opinions. Medical and technological advances can happen quickly in oncology. This was highlighted at a recent event, where GPs had the misconception that a colonoscopy held considerable risks for the patient. “With the benefit of recent figures – which showed that from 2010 to 2012, the risk of serious complication fell from 0.13 per cent to 0.04 per cent – our consultants were able to reassure GPs that a colonoscopy, which is frequently used to diagnose bowel cancers, is an effective and safe procedure.” Dr Javier Salerno, a GP from Croydon who has been attending GP Education Days since 2009, said: “I can’t encourage my fellow GPs enough to start coming to these events. I have been especially impressed by the motivation, engaging teaching skills and enthusiasm among the consultants to educate and inform us about the signs and symptoms to look out for in the early stages of cancer – and about the management of patients with cancer we can hopefully cure, if caught early enough. “Another interesting part is learning about advances in diagnostic and therapeutic management of cancers. This is particularly beneficial when I am talking to a patient in my surgery who may have cancer. I have found the diagnostic services at The Royal Marsden to be fantastic, and if a patient does find they have cancer, the advantage is they are already in the right place for prompt treatment.” For more information about the GP Education Series and to access case study webcasts, previous presentations and fact files, visit www.royalmarsden.nhs.uk/gp The Royal Marsden has made NHS history by treating a paediatric patient with CyberKnife while he was under general anaesthetic. Five-year-old Harry Parkes was diagnosed with a brain tumour at just 15 months old. When he relapsed for the second time, the decision was made to treat him using CyberKnife, a state-of-the-art machine that delivers radiosurgery with pinpoint accuracy. CyberKnife has been used to treat older paediatric patients at the hospital before, but Harry was the first to be treated under general anaesthetic, due to his age. Preparing for the 45-minute treatment was a multidisciplinary effort involving consultants, clinical oncologists, radiographers, nurses and the paediatric oncology and anaesthetics teams. “It was quite a feat,” said Consultant Clinical Oncologist Dr Henry Mandeville, who planned the treatment, “but it was worth it to see Harry doing well.” The Royal Marsden Private Care 5 Research WOMEN IN RESEARCH Making their mark The Royal Marsden is committed to promoting the role of women in research. Here, we profile three women who are making a valuable contribution he Royal Marsden and The Institute of Cancer Research (ICR) are working towards achieving the Silver Award from the Athena SWAN Charter – which promotes women in science, technology, engineering, medicine and mathematics – by 2016. The Royal Marsden and the ICR represent the only specialist Biomedical Research Centre (BRC) for cancer in the UK. We have a proud history of supporting and championing women in medical research, with several female clinicians leading studies and trials and developing new treatments. The following women are all making valuable contributions to our pioneering research. T DR SUSANA BANERJEE CONSULTANT MEDICAL ONCOLOGIST AND RESEARCH LEAD, GYNAECOLOGY UNIT “It is an exciting time to be working in cancer research and to be part of the revolution, improving treatment for women with gynaecological cancers,” says Dr Banerjee. “The latest technologies and knowledge of molecular biology mean it is becoming possible to deliver precision medicine and offer personalised treatment.” As the Chief Investigator for several clinical trials, Dr Banerjee is collaborating with scientists at the ICR to increase the understanding of genetic and molecular abnormalities to help advance treatments for 6 The Royal Marsden Private Care women with gynaecological cancers. Her research includes developing treatments for ovarian cancer patients with a BRCA gene mutation. Drugs called PARP inhibitors have shown exceptional results. Dr Banerjee was awarded funding for a clinical trial of the use of abiraterone – a drug developed at The Royal Marsden and the ICR that has transformed prostate cancer treatment – in ovarian cancer. “I am passionate about treating women who have gynaecological cancers,” she says. “There is an urgent need to improve treatments and survival. This can be achieved by clinicians, scientists and patients working together.” A consultant at The Royal Marsden for two years, Dr Banerjee is a recognisable figure on the global cancer research stage and has a catalogue of awards and honours. As well as regularly presenting her research at international meetings, she is a Key Opinion Leader for the European Society of Medical Oncology’s forum Women 4 Oncology, which aims to build a network of female oncologists and help them access leadership positions. “I am often asked for career advice from women training to be cancer specialists,” she says. “One of my key aims is to mentor the next generation of women in oncology and research and to be a positive role model.” DR AISHA MIAH CONSULTANT CLINICAL ONCOLOGIST, SARCOMA UNIT Dr Miah developed an interest in research as a trainee in the Head and Neck Unit, where she undertook a PhD in Clinical Oncology under Professors Chris Nutting and Kevin Harrington. “What really inspired me was the patient-centred, ‘can-do’ attitude,” says Dr Miah. “I felt encouraged by senior clinicians to pursue research – and this is still the case. During my time in the unit, I worked on local and national clinical trials, which provided me with excellent experience to develop a research programme in my current post.” Since joining the Sarcoma Unit in 2011, Dr Miah has developed the radiotherapy research programme, participating in a Phase III study evaluating the role of pre-operative radiotherapy in retroperitoneal sarcomas, and joining with colleagues from other institutions to look at the benefits of pre-operative radiotherapy in specific histological subtypes. “I have been grateful to BRC funding avenues for project grants for our smaller studies, which will help me to develop a larger portfolio of clinical trials and seek research grants to support the Sarcoma Research Unit,” says Dr Miah. “Sarcoma is a rare cancer so it is essential we collaborate with national and international centres to recruit patients to Phase II/III studies.” Dr Miah praised the guidance within the unit from Research This photograph: Dr Susana Banerjee. Below: Miss Fiona MacNeill. Previous page: Dr Aisha Miah Lead Professor Ian Judson and the multidisciplinary approach to both research and the treatment of patients. “My aim is to continue to pursue the development of future clinical studies,” she says. “Helping to improve treatments and patients’ quality of life drives me.” “IT ISN’T ALWAYS POSSIBLE FOR SURGEONS TO SPEND A LOT OF TIME IN THE LAB, BUT BY WORKING IN PARTNERSHIP WITH OTHER COLLEAGUES, THERE ARE OPPORTUNITIES TO BE INVOLVED IN IMPORTANT RESEARCH” MISS FIONA MACNEILL, CONSULTANT SURGEON MISS FIONA MACNEILL CONSULTANT SURGEON, BREAST UNIT A Breast and Reconstructive Surgeon, Miss MacNeill has always had an interest in breast cancer research. It began during her time as a Clinical Research Fellow in The Royal Marsden’s Breast Unit with Professor Trevor Powles, who retired in 2003, and working in the research laboratories with Professor Mitch Dowsett, who is now Head of the Centre for Molecular Pathology. Developing new surgical techniques is a major focus. Miss MacNeill and her surgical colleagues have been key in the development of oncoplastic breast surgery – combining the best cancer and plastic surgery techniques to maintain the breast’s appearance. She says: “It isn’t always possible for surgeons to spend a lot of time in the lab, but by working in close partnership with scientists and other colleagues, there are many opportunities to be involved in innovative and important research.” Miss MacNeill continues to work with Professor Dowsett and Professor Ian Smith, Head of the Breast Unit, in clinical trials. Together, they found that significant changes take place in the proteins of a breast cancer tissue sample within 30 minutes after its removal from a patient and before its arrival in the laboratory, where it is preserved for further analysis. Miss MacNeill, who was responsible for collecting the tumour samples in the operating theatre, adds: “This collaborative study led to an important scientific paper, which will influence how we design future trials that rely on examining cancer-tissue biopsies.” The Royal Marsden Private Care 7 Cancer focus Both our Sutton and Chelsea hospitals have received new scanners thanks to a multimillion-pound investment 8 The Royal Marsden Private Care Diagnostic imaging INVESTING IN SCANNERS Equipped for excellence With new scanners installed at both our hospitals, The Royal Marsden is now able to offer patients a more flexible, efficient and personalised service he Royal Marsden has upgraded its diagnostic imaging services in Sutton and Chelsea, following a multi-million-pound investment. In Chelsea, the Reuben Imaging Centre has two new, high-tech MRI scanners, thanks to £6.9 million raised by The Royal Marsden Cancer Charity. Having a 1.5T and a 3T MRI scanner will allow the maximum flexibility in clinical practice, which will aid the development of personalised treatment plans and give patients access to clinical trials that rely on very high-resolution images. The new centre, which is due to be completed later this year, will also include two new CT scanners. MRI scans are particularly important for soft-tissue cancers – such as brain, spinal cord, bowel, gynaecological and prostate cancers – as the magnetic T resonance uses the properties of the soft tissue to create the detail in the image. The combination of two MRI scanners with different performance specifications enables us to deliver a comprehensive service. The 1.5T MRI scanner has a larger field of view, which can facilitate the future development of whole-body imaging. In contrast, the 3T MRI scanner provides incredible detail over a smaller field of view, allowing us to undertake clinical research trials that require this level of visual detail. Over in Sutton, a newly opened PET/CT imaging facility, co-funded by The Royal Marsden and The Institute of Cancer Research, is equipped with two state-of-the-art PET/CT scanners. As one of the UK’s largest hospital-based providers of PET/CT scanning, the Trust can now scan more private patients more efficiently and in more comfortable surroundings. PET/CT scans can help to diagnose cancer and show what stage it is at. They also help specialists to decide whether a patient should have surgery or another form of treatment and to assess how well a treatment is working. Capable of distinguishing between scar tissue and active cancer tissue, the scans can also indicate whether a cancer has returned. Bernadette Cronin, Deputy Director for Clinical Services, says: “Since The Royal Marsden installed its first PET/CT scanner 10 years ago, the use of this technology for routine diagnosis, follow-up and support of Phase I, II and III research trials has increased substantially, from 500 to 3,500 examinations every year. “The new facilities across both sites mean that we can now scan more patients more efficiently using state-of-the-art technology – and offer our patients and research teams the best standard of care.” PATIENT CASE STUDIES Marcia Gardner Marcia (pictured above left), who is being treated for lung cancer as a private patient under the care of Dr Mary O’Brien (above right) and her team, has had two PET/CT scans at the new facility in Sutton. Marcia says she was impressed with the new facilities and the quality of her images. “The lovely facilities and the staff working there make it a lot easier to have the scans, and the 3D image that they get afterwards is really impressive,” she says. “It is important for me to be able to see what is going on inside my body. Not only does the image help the team caring for me plan my surgery in detail, it also makes it easier for them to explain to me what is going on inside me and what that means for my treatment. “This is the fourth time I have had cancer so it is very important to me that I know what is going on, and the scans really help me with this.” Seth Stiles Private patient Seth, 46, is being treated by Professor Kevin Harrington and recently had a scan at the hospital. Seth was originally diagnosed with cancer of the tonsils in Canada in 2010, and became a Royal Marsden patient at the beginning of 2013 after it was revealed that his cancer had spread to his lymphatic system. Following treatment, he began to receive follow-up scans every three months to see if his cancer has been successfully treated. A recent scan has shown an anomaly in his lung and he is now awaiting further results. “My experience of the hospital has been very positive,” says Seth. “The facilities there are fantastic and the staff are great and very reassuring. I am feeling well in myself and, whatever happens in the future, I know that with Professor Harrington and the whole team helping to treat me, I have the best care.” The Royal Marsden Private Care 9 Urological cancers EXPERT Q&A Diagnosis without delay Mr Pardeep Kumar, Consultant Urological Surgeon, explains the diagnostic process for urological cancers at The Royal Marsden hat are the signs and symptoms of urological cancers? Urinary tract symptoms that should prompt rapid referral include blood in the urine, pain in the loin, atypical urinary symptoms or a new palpable lump within the scrotum. Symptoms of urinary tract cancers are non-specific, so any patient presenting with the above symptoms requires investigation to rule them out. Blood in the urine is often the presenting sign in bladder cancer, and may also lead to the diagnosis of kidney or prostate cancer. Difficulty passing urine or symptoms of urinary tract infection that do not respond W to antibiotics also require investigation. The typical presentation for testicular cancer is a young man who has felt a new lump in the scrotum. How are they diagnosed at The Royal Marsden? Patients referred for rapid diagnosis come to the Rapid Diagnostic and Assessment Centre (RDAC) in the morning and undergo urine and blood tests, along with imaging that is appropriate to the case. This will depend on the patient, but could include ultrasound, CT or MRI scans. In men who are suspected of having prostate cancer, careful counselling takes place prior to commencing the diagnostic pathway. This may include repeat urine testing and a PSA blood test. Appropriate patients may proceed to a prostate biopsy on the same day. A targeted prostate biopsy using the latest techniques is possible by carrying out MRI scanning and incorporating the information into biopsy technology that is unique to The Royal Marsden in the UK. What techniques or equipment are used? The Royal Marsden’s RDAC has the latest diagnostic equipment available. Our MRI scanners produce the highest-resolution images available commercially. In prostate cancer diagnosis, we use a method of combining MRI scans with real-time ultrasound to target lesions within the prostate – a unique system in the UK. What is the referral process for private patients? If a patient requires a rapid diagnosis of a suspected urological malignancy, call our central referral line on 020 7811 8111 to make an appointment that is convenient for your patient – it is open seven days a week. “IN PROSTATE CANCER DIAGNOSIS, WE COMBINE MRI SCANS WITH REAL-TIME ULTRASOUND. THIS IS UNIQUE IN THE UK” MR PARDEEP KUMAR, CONSULTANT UROLOGICAL SURGEON 10 The Royal Marsden Private Care Staff profile STAFF FOCUS Gwynedd Burgoyne and Suzy Halliday Clinical Nurse Specialists in breast care wynedd Burgoyne (above left) and Suzy Halliday (above right) are Clinical Nurse Specialists (CNS) for The Royal Marsden’s Private Care service in Chelsea and Sutton respectively. Working closely with the plastics, pain and metastatic CNSs as key members of a multidisciplinary team, they are on hand to support breast cancer patients throughout their cancer journey. “We usually meet a patient at their diagnosis with the surgeon,” says Suzy. “We take part in the diagnosis discussion and are involved in every step of the treatment. A large part of our role involves counselling.” After the meeting with the G surgeon, the CNS talks through everything again with a patient, going over any concerns or questions. “Patients might be offered surgery followed by adjuvant chemotherapy, or neo-adjuvant chemotherapy,” says Gwynedd. “If women opt for reconstructive breast surgery, we prepare them for this major intervention to help facilitate a smooth recovery.” At this stage, a CNS may show patients pictures of different types of breast surgery to give them an idea of what to expect and to help them make a decision. “Our role is also to support patients on the ward after surgery,” continues Gwynedd, “to discuss practical issues such as bras, wounds, healing and recovery at home. During this time, we triage patients regularly on the phone.” At the follow-up consultation for histology results, which will dictate the rest of their treatment, a CNS is available to support the patients. At this stage, patients “WE ARE INVOLVED IN EVERY STEP OF THE TREATMENT. A LARGE PART OF OUR ROLE INVOLVES COUNSELLING” SUZY HALLIDAY, CLINICAL NURSE SPECIALIST will be referred for chemotherapy or radiotherapy, overseen by a medical or clinical oncologist. Gwynedd says: “We discuss the treatment regime, which is tailored to suit each patient, and any side effects. Around three to five weeks after surgery – if chemotherapy has already been given neo-adjuvantly or is not required – patients may have radiotherapy. We support them closely through this process too.” An important part of a CNS’s role is preparing patients for the future. Losing the regular attendance at hospital can be daunting. A CNS will continue to support a patient regularly at this stage, providing continuity and helping to dispel fears. The Royal Marsden Private Care 11 Only Royal Marsden Private Care offers exceptional standards of personalised care supported by the knowledge, expertise and world-leading approach of The Royal Marsden. Private patients see their chosen consultant throughout their treatment and receive the full support of our specialist cancer teams in exclusive private facilities. Private patient services Inpatient and outpatient private wing and Medical Day Care Unit; daycare facilities. Diagnosis Rapid Diagnostic and Assessment Centre and Clinical Assessment Unit; specialist pathology services. Surgical theatres and critical care Imaging services Extensive CT and Eight state-of-the-art MRI facilities and theatres; the UK’s the latest PET/CT only Level 3 Critical scanners. Care Unit for cancer. The Royal Marsden welcomes NHS and private patients. For more information on our Private Care Service, or if you would like to refer a patient from either the UK or overseas, please call our Central Access and Referral number on +44 (0)20 7811 8111 or email privatepatients@rmh.nhs.uk The number is staffed by both English and Arabic language speakers. For information on our consultants, please visit www.royalmarsden.nhs.uk