FREEDOM OF INFORMATION REQUEST
Melanoma Taskforce FOI request into NHS care for patients
with melanoma
Name: Elizabeth J C Stewart
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ________________________________________
Position: Consultant Dermatologist and MDT skin cancer lead
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Name of NHS Acute Trust: Wrightington Wigan and Leigh NHS
Foundation Trust
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________ _
__________________________________________________________________
Name of FOI Lead: Natalie Robinson
__________________________________________________________________
Email: Natalie.a.Robinson@wwl.nhs.uk / FOI@wwl.nhs.uk
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________________________________
Please return your completed response to the Melanoma Taskforce secretariat:
Daniel Cambers
Melanoma Taskforce Secretariat
c/o Insight Public Affairs
52 Grosvenor Gardens
London
SW1W 0AU
Email: daniel@insightpa.com
Tel:
020 7824 1857
Fax:
020 7824 1851
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Under the Freedom of Information Act 2000, the Melanoma Taskforce is writing to Strategic Health
Authorities (SHAs), NHS Acute Trusts and Cancer Networks to request the following information:
SECTION ONE
Adherence to Melanoma Patient Pathways
1) Does your Trust have its own standard clinical pathway for the diagnosis, management
and treatment of patients with melanoma? Place an X in one box. If the answer is yes, please go to
question 4.
Yes
X
No
2) Does your Trust have any plans to introduce a standard clinical pathway for melanoma?
(Place an X in one box)
Yes
No
3) Does your Trust follow the published melanoma patient pathway of another Trust, SHA
or cancer network? (Place an X in one box)
Yes
No
If yes, please provide further details
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__________________________________________________________________________
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4) Is the Trust’s pathway publicly available? If so, please state below where the pathway can be found.
Yes
No
X
Whilst the Trust do not currently publish the melanoma pathway it is aligned to the Network
approved pathway which is present on the Network website, additionally all pathways are included in
the Trust Skin Operational Policy submitted to Peer Review via CQuINS
5) When was your melanoma patient pathway first published?
N/A
6) When was the pathway last updated?
September 2011
7) Which of the following sources or other pieces of guidance, if any, were referred to in
the construction of the pathway? Place an X in each box that is applicable.
British Association of Dermatologists, ‘Revised UK Guidelines for the Management of
Cutaneous Melanoma 2010’
X
European Society for Medical Oncology, ‘Melanoma: Clinical practice guidelines for
diagnosis, treatment and follow-up’, 2010
NHS Map of Medicine
NICE CGSTIM ‘Improving Outcomes for People with Skin Tumours Including Melanoma’,
2010
Royal College of Physicians, ‘The Prevention, Diagnosis, Referral and Management of
Melanoma of the Skin’, 2007
None of the above
Other(s), please state
Merseyside & Cheshire Cancer Network
X
X
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8) Do you carry out regular audits to ensure that the pathway is being followed? (Place an X
in one box)
Yes
X
No
9) If so, when was the last audit carried out?
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10) What were the levels of adherence to the pathway shown by the most recent audit?
Please provide as much detail as possible.
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SECTION TWO
Patient Care in Melanoma
Section two of the survey is split into five short sections. Please answer all questions that are applicable
to your Trust.
PART ONE: DIAGNOSIS AND REFERRAL
11) How many GPs with a Special Interest in Dermatology practice within your Trust?
One but she has no role in skin cancer diagnosis and management
________________________________________________________________________
12) What training in melanoma does your Trust encourage GPs to undertake? Please tick all
boxes that are applicable.
Continuous Professional Development
(CPD) courses
Online training courses
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X
No courses offered / encouragement
Please provide any further explanatory information
No specific training recommendations are made to the GPs. As MDT lead I communicate
with the few GPs in our area who have excised an unexpected melanoma (There were 2
cases in 2010 out of a total of 72 primary melanoma diagnoses, both unexpected
diagnoses). We have no GP skin cancer surgery in this area ie GPs knowingly excising skin
cancers. This is an agreement with the local PCT and the GPs have been in favour of this.
Our referral proforma has recently been updated in a bid to help GPs differentiate the MM
from the benign moles. This is just being introduced to the GPs and the impact on 2 week
referrals will be audited.
The department runs a teaching session three times/yr (Teach and Treat). This is an
evening session, open to all GPs and practice nurses and very popular. We cover various
skin lesions and rashes in the session using unscreened patients and skin lumps and bumps
including benign naevi and the differential from malignant melanoma comes up in the
discussion most sessions
PART TWO: MELANOMA MANAGEMENT
13) Does your Trust have a Specialist Skin Multidisciplinary Team (SSMDT)? (Place an X in
one box) If the answer is no, please go to question 15.
Yes
No
X
14) Which of the following professionals are represented on your SSMDT? Please place an X in
the box for all those that apply.
Dermatologist
Plastic Surgeon
Clinical Oncologist
Medical Oncologist
Melanoma Specialist Nurse
Pathologist
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Radiologist
Other
15) How many melanoma nurse specialists currently practice within your Trust?
We have one skin cancer nurse specialist. Her job is to support all patients with skin
cancer, not just the patients with malignant melanoma.
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16) Does your Trust undertake Sentinel Node Biopsy? (Place an X in one box)
Yes
X
No
If the answer is no, please describe why your Trust does not use Sentinel Node Biopsy.
The plastic surgery service is provided as an outreach service from Whiston Hospital (St
Helens and Knowsley NHS Trust). The sentinel lymph node service is based at Whiston
hospital where the in-patient beds and diagnostic facilities are. Patients who should be
offered sentinel lymph node biopsy are referred to the sentinel lymph node team at
Whiston and seen by the relevant consultant team in clinic. Such patients are discussed at
the LSMDT. Whiston Hospital hosts the SSMDT and patients are discussed there post
surgery.
17) For what purposes does your Trust use Sentinel Node Biopsy? (Place an X in all boxes that
apply)
As a prognostic tool in a defined
subset of patients
As part of ongoing research
In order to provide continued practice
to maintain clinical skills
PART THREE: MELANOMA TREATMENT
18) Which of the following potential melanoma treatments are available within your Trust?
For each, please state whether the treatment is fully funded by the Trust, available through Individual
Funding Requests (IFR), available via the Cancer Drugs Fund (CDF) or through clinical trials.
Treatment
Fully Funded
by Trust
Funded via
IFR
Funded via
CDF
Available
only in
clinical trials
Not available
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Bevacizumab
X
Carmustine
X
Cisplatin
X
Dacarbazine
X
Interferon-alpha
X
Interleukin-2
X
Ipilimumab
X
Tamoxifen
X
Vemurafenib
X
Vinblastine
X
All Chemotherapy undertaken at Clatterbridge Centre for Oncology
Please use the table below to provide details of any other treatments not listed above
Treatment
Fully Funded
by Trust
Funded via
IFR
Funded via
CDF
Available
only in
clinical trials
Not
available
19) Are patients routinely made aware of clinical trials taking place that may be
appropriate for them? Place an X in one of the boxes below
Yes
No
Currently no trials open for
patients with Stage 1A disease.
Other patients are referred to
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Whiston where trial entry is
discussed
20) Are patients routinely made aware of clinical trials that may be appropriate for them
that are taking place in another Trust? Place an X in one of the boxes below
Yes
No We do not routinely discuss
trial entry with a patient who has
just heard that the lesion they
have had removed is a significant
skin cancer which needs further
surgery as we feel this is
inappropriate.
As detailed above, patients are
invited to participate in trials at
Whiston
(oncology service
from Clatterbridge Hospital)
X
PART FOUR: END OF LIFE AND PALLIATIVE MELANOMA CARE
21) Which of the following factors might lead the Trust to consider referring patients to
specialist palliative care services? Place an X in all boxes below that are applicable.
Complex symptom management issues
X
Difficulties in adjusting to the diagnosis or disease progression
X
Psychological and family issues - such as communication problems within
the family
Spiritual issues - such as the challenging of belief system/faith/cultural
values as a result of the cancer
Other (please provide further details below)
X
X
We do not deal with advanced disease on a regular basis.
Most patients who present with a skin primary and are
found to have higher stage disease (usually +ve nodes)
remain under SSMDT FU. There have been over the years
just a few patients presenting with unexpected advanced
disease requiring intervention from the palliative care
team. They have been referred by the clinician involved in
their care without direct involvement of the Skin MDT. As
LSMDT lead, I have been aware of this decision but have
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not become involved clinically.
None of the above
22) What proportion of patients within your Trust decided against receiving treatment for
Stage IV melanoma in the last year for which data is available?
n/a
PART FIVE: PATIENT EXPERIENCE & INFORMATION
23) What sources of advice and information does your Trust use to provide information to
patients about how to self-examine for signs of melanoma or metastases? Please tick all
boxes that apply
NHS Choices
National Cancer Action Team
Cancer Research UK
Macmillan Cancer Support
X
British Association of Dermatologists
X
None of the above
Other (please state and provide further detail below)
24) At which of the following stages does your Trust provide reassurance and psychological
counselling routinely for melanoma patients?
Primary presentation
Referral
Diagnosis
X
Management
X
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Progression to advance disease
Palliative and end of life care
Every stage
No stage
Support is provided by the clinicians involved in the patient’s care, including the Skin cancer nurse specialist .
SECTION THREE: Additional Information
25) Please indicate which of the following you believe would improve care for patients with
melanoma. Please place an X in all boxes that you think apply
More money and resources
Better information and data
A comprehensive and standard clinical pathway
X
Commissioning Support / Guidance
None of the above
Other (please state and provide further details below)
Care is provided best where the clinicians from GP to
dermatologist to specialist surgeon work together in the
best interests of the patient. Communication and team
working are the key to providing good care whatever the
clinical problem. One size never fits all and local teams
should be able to draw on local resources. Commissioners
need to understand this when looking at services.
Services need to be able to provide the data to show their
service works and delivers good clinical care with excellent
patient satisfaction.
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