All posts by Steve

NICE Sarcoma Quality Standard

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NICE has just published its quality standards and guidance for Sarcoma at http://www.nice.org.uk/guidance/qs78.

There’s a list of 6 quality statements on the website at http://www.nice.org.uk/guidance/qs78/chapter/list-of-quality-statements

Statement 1.  Sarcoma advisory groups and sarcoma multidisciplinary teams (MDTs) have
pathways for referral and diagnosis in place for people with suspected sarcoma.

Statement 2. Adults, children and young people with bone sarcoma and adults with soft tissue  sarcoma have their care plan confirmed by a sarcoma MDT and treatment delivered by services  designated by the sarcoma advisory group.

Statement 3. Sarcoma MDTs publish information about their shared pathways, activity and  patient outcomes, including information on site-specific sarcomas.

Statement 4. People with a retroperitoneal sarcoma are referred before having any treatment to  a sarcoma treatment centre with special expertise in managing this type of tumour.

Statement 5. Surgeons performing planned resections of sarcomas are core or extended
members of a sarcoma MDT.

Statement 6. People with sarcoma are supported by an allocated key worker with specialist  knowledge of sarcomas and their treatment.

© NICE 2015. All rights reserved. Last modified January 2015

Local Charity Event

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Come in pink posterThere’s a Charity Event on 7th February 2015 in the Allendale Centre in Wimborne to raise funds for Cancer Research UK and Poole Hospital Ladybird (Breast Care) Unit.

It features a local band ‘The Alibi’ and a Representative coming from Cancer Research UK to give a short talk during the Band’s break on the importance of self examination and early detection.

For details see Steve Cassidy’s comment on our blog
here and his website Come In Pink

Local Community Magazine draft editorial

The challenge of being a GP

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David Haslam, Chair of NICE in his post Risky business: the challenge of being a GP says

Signs of cancer may also not be clear or obvious and GPs see, on average, only around eight new cases a year. A full time GP will have between 6,000-8,000 appointments every year. And they will only have around 10 minutes per appointment to pick out warning signs that could be cancer, but equally may be a symptom of a less serious condition.

Sarcoma UK’s On The Ball campaign is still going to help with diagnosis.

NICE Draft Suspected Cancer Guidelines

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NICE is redrafting its guidelines on suspected cancer. http://www.nice.org.uk/guidance/indevelopment/gid-cgwave0618/consultation. Sarcoma is on pages 272-281 of the Full version. Here are some of the sarcoma guidelines.

See result of consultation: Suspected cancer: recognition and referral

Bone sarcoma

Around 500 new bone sarcomas are diagnosed each year in the UK, meaning that a full time GP is unlikely to diagnose more than one bone sarcoma during their career. It is seen in both sexes, and is one of the commoner cancers in children, teenagers and young people.

Pain and loss of function of the affected limb are thought to be the main presenting 6 symptoms of bone sarcoma. However the rarity of this cancer means there are few studies of its clinical features.

Because of the rarity of bone sarcoma, there is no standard diagnostic pathway for primary care. Plain X-ray may show abnormalities suggestive of the sarcoma.

Clinical questions
  • What is the risk of bone sarcoma in patients presenting in primary care with symptom(s)?
  • Which investigations of symptoms of suspected bone sarcoma should be done with clinical responsibility retained by primary care?
Recommendation

Consider an urgent direct access X-ray (within 2 weeks) to assess for bone sarcoma in children and young people with unexplained bone swelling or pain. [new 2015]

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for people if an X-ray suggests the possibility of bone sarcoma. [new 2015]

Soft tissue sarcoma

Just over 3,000 new soft tissue sarcomas are diagnosed each year in the UK. A full time GP is likely to diagnose approximately 1 person with soft tissue sarcoma during their career. They occur in connective tissue, so can occur in many parts of the body. Five year survival is highly dependent on the specific site.

The rarity of this cancer means there are few studies of its clinical features. It is believed that most present with a mass, which may be painless, and may become quite large. The main method of diagnosis is by biopsy, which is performed in secondary care.

Clinical questions
  • What is the risk of soft tissue sarcoma in patients presenting in primary care with symptom(s)?
  • Which investigations of symptoms of suspected soft tissue sarcoma should be done with clinical responsibility retained by primary care?
Recommendation

Consider an urgent direct access ultrasound scan (within 2 weeks) to assess for soft tissue sarcoma in people with an unexplained lump that is increasing in size. [new 2015]

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for people if they have ultrasound scan findings that are suggestive of soft tissue sarcoma or if ultrasound findings are uncertain and clinical concern persists. [new 2015]

RNOH Stanmore

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RNOH Stanmore is a fascinating place. First impression is shock at the age of the buildings but that soon disappears when you meet the wonderful staff and get the best treatment in the world. The place has a charm of its own that is irresistible. The corporate video at https://www.rnoh.nhs.uk/about-us is not just the puff you expect and is worth watching.Even more fascinating is the 48-minute interview on Radio Brockley with the CEO Rob Hurd, discussing a range of topics from the disappointing CQC report to talking about the shuttle bus, via future plans for new buildings and the academic centre in conjunction with University College Hospital. You can listen to it at https://www.youtube.com/watch?v=dJCDNKuJksQ.

Cross Cancer Out Campaign

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As part of Cancer Research UK’s “Cross Cancer Out” General Election campaign, if you go to https://www.cancerresearchuk.org it will enable you to email your parliamentary candidates about the need to improve cancer survival in the UK. The site will find the details of your candidates for you and email them, including an optional message from you.

My personal message was:
Sarcoma is a rare form of cancer and is often not spotted early enough by GPs or hospitals with survival rates only 55%. We need to put more resources into early diagnosis.

Message from Cancer Research UK:

Here are details about our ‘Cross Cancer Out’ General Election campaign which we have launched today. Our aim with this campaign is to ensure that tackling cancer is a political priority for all parties. We will be doing a lot of work in the coming months up to the election to raise public support and get these messages across MPs and parliamentary candidates.

The ‘Cross Cancer Out’ campaign will focus on a number of key commitments aimed at improving cancer survival in the UK including:

  • Equal access to innovative radiotherapy, surgery and effective cancer drugs, including drugs targeted to patients’ tumours;
  • Continued support for campaigns to raise public awareness of the signs and symptoms of cancer;
  • A commitment to increase participation in the national bowel cancer screening programme.

As you can see, access to treatments – including improving radiotherapy – features strongly in the campaign.

Further information and actions can be found on the website: https://www.cancerresearchuk.org

Best Places to Work

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From the Health Service Journal’s Best Places to Work:

Royal National Orthopaedic Hospital Trust

  • Full time permanent staff: 1,298 WTE
  • Voluntary staff turnover: 14 per cent
  • Exec team male/female ratio: 70 per cent male/ 30 per cent female
  • Programme to recruit ethnic diverse staff: No

As its name suggests the trust specialises  in neuro-musculoskeletal care. It delivers  well on the training of its staff with 87 per  cent having received health and safety training, 77 per cent having equality and  diversity training and 88 per cent having been appraised in last 12 months. As the largest orthopaedic hospital in the UK, it plays an important role in teaching and training with over 20 per cent of orthopaedic  surgeons in the UK receiving their education at the trust.

The Royal Marsden Foundation Trust

  • Full time permanent staff: 2,377
  • Voluntary staff turnover: 12 per cent
  • Exec team male/female ratio: 40 per cent male/60 per cent female
  • Programme to recruit ethnic diverse staff: No

The Royal Marsden offers a free travel clinic and immunisation service to its staff and promotes a cycle to work scheme. Open meetings with the chief executive are held regularly and the trust runs a local employee of the month scheme.