Head & Neck Network Site Specific Group Draft Minutes
Friday 25th September 2015
Burrator Room, Lakeside Conference Centre, Roadford Lake
Attendees:
Andrew McLennan, RDE (Chair)
Katerina Anesti, RDE
Chris Wallace, RDE
Claire Barber, RDE
Chris Hamilton, RDE
Paul Farrand, Exeter University
David Newman, RDE
Alfonsina Blackwell, RDE
Mac Merrett, Patient Rep
Wendy Cook, PCRN
Liz Boylan, PCN
Paul McCardle, PHT
Amy Roy, PHT
Tass Malik, PHT
Robert Lavis, PHT
Steph Murgatroyd, PHT
Emily Cruwys, ND
Graham Merrick, TST
John Hunter, TST
Joanne Greedy, TST
Richard Perriss, SD
Stephen Adcock, RCHT
Yvette Grobbelaar, RCHT
Zarina Shaikh, RCHT
Jacqui Williams, RCHT
Benjamin Rock, RCHT
Venkat Reddy, RCHT
Ruth Carr, SD
Deborah Howland, SD
Simon Hickey, SD
Daphne Carpenter, SD
Phil Reece, SD
Ed Chisholm, TST
Action
1.
2.
2.1
3.
3.1
4.
4.1
Welcome and Video Presentation
AM welcomed members and connected to a Skype presentation on the ‘Pathos
Study’ by Professor Terry Jones.
AM thanked the sponsors for funding the venue and cost of refreshments for the
event and Rachael for organising the facilities at Lakeside.
Pathos Study – Discussion on presentation
Keen to take part in the study but currently don’t have access to TORS although
there is a robot at the RDE some questions were raised about the criteria re
numbers that could be part of a trial if being treated by laser not robot.
Must do 5 cases. Need to see first before submitting to Pathos.
Queried whether QA for radiotherapy being piggybacked onto other studies.
To give chemo weekly or 3 weekly is a local choice
Minutes / Actions from meeting held 13th May 2015
The minutes were agreed as an accurate record by those who attended.
Future NSSG Meetings – Network-wide meetings will be held twice yearly in
future. First meeting arranged for 25th September 2015 at Lakeside Conference
Centre, Roadford Lake which will be preceded by a separate Endocrine and
Thyroid NSSG meeting and guest speaker over lunch.
Terms of Reference / Constitution update
Core members – add dietician and speech therapist
Chairmanship – AM chaired this meeting. Chair for next 3-year term to be
agreed
Meetings – to be twice yearly
Educational element of meeting to be agreed between meetings to ensure
Action: LB to update Terms of Reference and Constitution for sign off by Chair.
Clinical Guidelines
It was agreed that the Peninsula Head and Neck NSSG Clinical Guidelines would
reflect those adopted by the SWAG (Somerset, Wiltshire, Avon and
Gloucestershire) Cancer Services and refer directly to the Scottish Intercollegiate
Guidelines for the Diagnosis and Management of Head and Neck Cancers (SIGN)
and the British Association of Head and Neck Oncologists (BAHNO) National
LB
4.2
5.
5.1
5.2
5.3
5.4
5.5
6.
6.1
6.2
6.3
Clinical Guidelines, with the exception of thyroid guidelines.
Action: LB to rework SWAG document and circulate to members
LB
The Endocrine & Thyroid NSSG will be asked to review current guidelines and
present for approval at next Endocrine & Thyroid NSSG in May 2016.
Enhanced Recovery
Not just after surgery but integrated care assessment. As soon as seen in unit
patient goes to assessment nurse even before sure they need surgery.
AM mapped where info goes, who needs it and when.
Doing audit from March back 1 year and from Oct 15 forward for 6 months.
Feeding care assessment pack, patient diaries and standardised operation
sheets.
David Newman, Library & Information Skills Trainer at RDE, has created a
database to assess data collected. This is still embryonic but should prove useful
for surgeons, nurses, oncologists, therapists and good for audit and research
purposes
A gap had been identified between getting approval for audit and putting it in
format suitable for analysis & report. A booklet was available showing current
fields collected.
Items to be considered - What do you record?
- What is priority?
- How do you want to group it?
- How do you want to analyse it
- Functionality, ease of use
- Calculations
- Error checking
- Categorised results
Audit Projects
Graham Merrick leading audit for group for now
Did a successful audit 2 years ago on use of gastrostomies and complication
rates. Hard to organise due to communication across network. Needed
improved links.
New Audit – ‘Time from Surgery to commencement of Radiotherapy’. Look at
reducing time from 12 to 8.3 to 7 weeks. David Hwang’s Registrar did a piece of
work with RDE couple of months ago – GM will send out proforma. Do as
network audit looking at local and network wide results.
Action: GM to send out proforma used by DH Registrar
GM
Key individual identified to lead at each site:
SD - Ruth Carr / Simon Hickey
PHT - Amy Roy/ Tass Malik
ND/RDE - David Hwang/Clare Barber
RCHT - Steven Adcock/Venkat Reddy
TST - Graham Merrick/ Petra Jankowska
6.4
Do retrospective then prospective. Include factors affecting delay and a
narrative section about post op complications. Collect data from Sept 14 – Sept
15 / 3 month review or ongoing / 6 month review at next meeting
Look at each case to see what impact change has & see about bringing it down
Action: GDM to analyse data for next NSSG in May 2016
7.
PHANCS / Patient Representation
1. Mac Merrett gave an overview of the progress made by a group of 2 nd year
dental students from the Peninsula Dental School. The project PHANCS
GM
(Peninsula Head and Neck Cancer Support) aims to raise awareness about Head
and Neck Cancer. The attached leaflet has been produced to provide general
help and guidance around common issues that may arise before, during and
after treatment. A ‘facebook’ page www.facebook.com/phancs has been
created.
8.
8.1
8.2
8.3
8.4
8.5
8.6
8.7
9.
10.
10.1
11.
The group was asked to let MM know of any patients who may be interested.
Research /Clinical Trials
WC outlined how clinical research support has changed in last 18 months. Now
only 15 networks with 13 subspecialty leads. David Hwang is subspecialty lead
for the Peninsula Head & Neck network. The Head and Neck portfolio is not
huge and WC asked that staff let her know of any studies they could pick up.
The current research report shows a drop in recruitment this year. CH
challenged the idea of attaching targets to studies was not practical and would
be more achievable if they could aggregate across the network.
WC advised that there are financial penalties for failing to recruit the anticipated
number of patients into a study. If you state you will have 5, then it must be 5 or
more but she did confirm that if you need to pull out because the study in
inappropriate, there would be no financial implication.
Head & Neck 5000 is no longer open, replaced by more complex, integrated
studies using smaller numbers.
De-ESCALaTE HPV study more challenging to recruit to than originally thought.
HOPON very challenging – apparently open but when discussed with research
teams no one knows about it.
Discussed accuracy of data. Partially caused by lag in time – data pulled 3 weeks
before meeting so latest recruitment not shown. September report not yet
ready. SH queried the accuracy of data for studies that have now been closed,
WC said if data not logged then officially haven’t recruited.
Elective vs Therapeutic Neck Dissection in Node-Negative Oral Cancer
CH presented the results of a large Indian study comparing elective nodal
surgery to watch & wait in early oral cancer. It is thought to be the first high
quality evidence in 40 years to inform this decision. Could be practice changing.
The PET-Neck Trial currently underway at 40 centres in UK aims to compare the
efficacy of a PET-CT guided watch and wait policy with the current practice of
planned neck dissection on overall survival, disease-specific survival, recurrence,
quality of life and cost-effectiveness in the management of advanced nodal
metastasis in patients treated with chemo/radiotherapy for their head and neck
squamous carcinoma primary. With good PET access in timely manner and
good reporting, CH suggested this should be looked at as the way ahead.
Similar paper done in Taiwan 2008. Not randomised
Living With and Beyond Cancer
Deferred to next meeting
Action: LB to invite Wendi Abraham to speak at next meeting
LB
Date of Next Meetings
Friday 13th May 2016 in the Burrator Room, Lakeside Conference Centre,
Roadford Lake, Devon PL16 0RL 1:30-4pm
Friday 18th November 2016 in the Burrator Room, Lakeside Conference Centre,
Roadford Lake, Devon PL16 0RL 1:30-4pm