Breast NSSG Annual Report
2010/11
Agreement Cover Sheet
This Annual Report has been agreed by:
Position:
Chair of the NSSG
Name:
Mr Neil Rothnie
Organisation:
Southend University Hospital NHS FT
Date Agreed:
1st September 2011
Position:
Chair of the Network Board
Name:
Sheila Bremner
Organisation:
NHS North Essex
Date Agreed:
20th September 2011
Category
Report
Introduction
This annual report from the Breast NSSG covers the period 1st April 2010 – 31st March 2011.
The NSSG was established following the merger of South Essex and Mid Anglia Cancer Networks in
2007. The key emphasis in 20008/09 and 2009/10 was consolidation of the group and implementing
the agreed network plans for delivering IOG compliant Breast Cancer services.
Key achievements in 2010/11 include:
•
The establishment of a moving on exercise group in North Essex.
This group met on two occasions during 2010/11 one business meeting and one audit event. Minutes
attached Appendix 1.
Key challenges where some progress made but additional work required next year, includes: strong
fully constituted MDTs (addressing any Peer Review shortfalls and presenting Commissioning Guide
Key Indicators for Breast cancer); IOG compliant breast cancer services across all localities; review of
NSSG constitution; greater commitment to network-wide audit and agreement of minimum dataset
(MDS) information systems.
NSSG
Meetings
Schedule /
Attendance
There have been two Breast NSSG meetings during 2010/11 one dedicated to business and one audit
event.
Annual Review
Date: 14th July 2011
Conducted by: Tom Carr, Medical Director
The attendance demonstrates involvement from core members from each of the four Breast MDTs
that serve the Essex Cancer Network (Appendix 3).
Breast NDR.doc
Activity
Overview
Breast Surgery
201011.xlsx
Surgical data is also included in part of the clinical lines of enquiry data within appendix 5.
Waiting Times
2010-11
Breast
2WW
BASILDON
CHELMSFORD
COLCHESTER
SOUTHEND
Grand Total
No.
981
1123
1216
1276
4596
%
95.80%
95.41%
97.05%
99.45%
97.02%
31 Day
No.
165
252
348
383
1148
%
100.00%
100.00%
100.00%
100.00%
100.00%
62 Day
No.
101
141
171
126
538
%
98.01%
95.73%
94.74%
98.41%
96.47%
Network Audit
A range of topics were presented at our Network audit event agreed via NSSG. Each project was
assigned a co-coordinator and the results of the projects were presented at our Half Day event in
October 2010 held at The Waterfront in Chelmsford. The meeting was highly successful and was well
attended by members of the NSSG as well as some external visitors. Audit flyer shown in appendix 2
Audit projects presented included
•
Management of Breast cancer in the Elderly.
•
HER2 availability
HER 2 Audit Oct
2010 55.ppt
The audit event was extended to include others working in breast care services outside of the NSSG
membership. A summary of attendance is included below:
Attendance Sheet
for 8.10.10 Audit.pdf
Breast “Lines
of Inquiry”
National Data
The tables setting out the ECN ‘Breast Clinical Lines of Inquiry (nationally available data) are set out in
Appendix 5.
We propose collecting the ‘Key Commissioning Questions’ data from each unit with individual, but
anonymised, surgical data to encourage IOG compliance.
Research
The Breast NSSG had agreed their list of clinical trials during 2009/10 and reviewed and updated this
list for 2010/11
Professor N Davidson has been elected as the Research Lead.
The agreed list and MDT recruitment levels into each clinical trial for the 2010/11(up to March 2011)
is listed in Appendix 4.
The NSSG at its meeting in March 2010 discussed clinical trial list for 2010/11 and activity lists (as
required by measure 1C-151) will be reviewed at all future meetings and action agreed as required
during 2010/11.
Patient &
Carer
Feedback and
Involvement
Each breast care nursing team has carried out a patient satisfaction survey annually and presented
findings & action plan to their own teams. This years survey is being collated as a network and will be
presented at the NSSG meeting in November 2011.
The group has active user members who bring patient issues to the NSSG.
The users also meet with their local breast care nurses to discuss local user support groups and the
establishment of moving on programmes.
Essex Cancer Network Breast Cancer NSSG meeting
Friday 8th October 2010
12 noon – 2.00pm
Essex Cardiothoracic Centre, Basildon Hospital
Minutes
Paul Sauven (Chair)
PS
Breast Surgeon, MEHT
Neil Rothnie (Deputy Chair)
NR
Breast Surgeon, SUHFT
Mr S. Chandra Sekharan
SC
Consultant Surgeon, CHUFT
Sharron Beesley
SB
Service User, ECN
Kathy Rooke
KR
Research Sister, Breast Care,
MEHT/CHUFT
Teresa Dearson (for Carolyn
Ollenbuttel
TD
Breast Care Sister, MEHT
Anne Robinson
AR
Consultant Oncologist, SUHFT
Wendy Ella
WE
Consultant Oncologist, SUHFT
Roger Whitney
RW
Consultant Radiologist, MEHT
Ashley Solieri
ASo
Research Network Manager, ECRN
Ms. Emma Grey
AR
Consultant Surgeon, SUHFT
Mr Ali Salih
AS
Breast Surgeon, BTUHFT
Khalid Al Janabi
KJ
Consultant Pathologist, MEHT
Asha Eliti
AE
Consultant Radiologist, SUHFT
Taghreed Toma
1.
TT
Consultant Radiologist, SUHFT
Apologies
Karen Hull, Reggie Inwang, Karen Reeve, Karen Travis, Karen
Duncombe, Carol Napper, Phil Murray, Nazira Visram
2.
Previous Minutes of NSSG – 5th March 2010
The minutes were agreed as a true record of proceedings.
3.
Matters Arising
3.1 Review 2009/10 Work Programme
•
Seeing all breast referrals in two weeks
None of the localities reported any problems with meeting this
standard.
•
Service Improvement
Clinical lines of enquiry
PS reminded the NSSG that each unit would be required to submit
individual consultant data on Mastectomy/Conservation ratios,
axillary clearance, immediate reconstruction rates, length of stay
and survival. He stated that he had significant reservations about
the appropriateness of the data being requested but that it was
not optional. Following discussion on the 5 additional lines of
enquiry it was also agreed that some of the information will not
accurately reflect activity and clear definitions will be required to
ensure consistency of the data. It was not clear whether the
questions referred to only invasive cancers or all cancers and NR
also was concerned as to who will be providing the information as
there were some questions as to the accuracy of the HES data.
AS will ask Sue Maughn to investigate who is expected to collect
the data.
Action:
AS
BCCOM data
All localities had submitted their data with Basildon submitting
theirs unchecked. NR stated that checking the data does improve
the accuracy however if Trusts have no support to undertake the
checking it is better to submit unchecked than not at all.
3.3 Peer Review
It was agreed that there is a lack of support at all localities for uploading
the documents required for peer review. Basildon and Chelmsford
MDT’s received a formal visit, reports available on CqUINS
3.4 Discuss and Agree Service Development priorities for Breast
Cancer
PS wished to defer this item
3.5 Network Constitution/Clinical Guidelines
PS will review and update the NSSG guidelines and circulate for
comments. PS requested that oncologists and radiologists review and
update their respective sections and similarly surgeons. The oncologists
requested that they undertake this following the SABCC international
meeting in December.
Action:
PS, surgeons, Oncologists and Radiologists
3.6 Data Collection
The Somerset System will eventually be in place across all MDT’s in the
ECN. Mid Essex reported they are piloting only target and not clinical
data on a couple of tumour sites, Colchester and Basildon had nothing to
report. Southend reported data was being collected at breast and
colorectal MDTs by the MDT co-ordinators; however they do not yet
know how robust the data is. PS reminded the NSSG that until all the
trusts were making Somerset available and supporting clinical data input
there was no likelihood of accurate data collection and it would be very
difficult to answer the clinical lines of enquiry.
3.7 Audit 2010/11
Audit topics already agreed as listed above –
a)
Elderly Audit. Lead – Neil Rothnie. - Presented 08.10.10
b)
HER2 availability – Presented 08.10.10
It was agreed that the topics for next year were:
•
•
•
Length of stay – Lead Emma Grey – 4/12 prospective data
collection February to May 2011. EG to circulate proformas by
Jan 2011 for comment
Satisfaction audit - Breast care Nurses –– TD reported the
proformas had been agreed. PS asked the nurses agree a time
table to undertake the survey and inform him. To be presented
at the October 2011 audit day.
Staging Investigations for Primary Breast Cancer – Lead
Taghreed Toma – 4/12 data collection (February to May 2011).
TT to circulate draft proformas to radiologists and then to PS by
Jan 2011
Date of Audit for 2011 to be agreed at next meeting.
3.8 Review and agree Clinical Trials for Breast Cancer
The current list of trials were agreed. ASo outlines the key peer review
measures of an NSSG lead for research and the NSSG informing the
MDT of the agreed list. The group felt they did not need to undertake
this as they regularly receive recruitment reports showing a good level of
recruitment.
WE reported that Basildon now had research nurse support and it was
hoped that recruitment would improve with the re-opening of
Persephone and Supremo, although there had been some problems
recently.
3.9 Breast CNS Up-date
Nil to report.
3.10 User Up-date
Nil to report.
4.
Any Other Business
4.1 Chair
PS reported that he was reducing his hours to part time in January 2011
and planned to demit his position as Chair on 1st April 2011. NR, as the
current deputy Chair, will take over as Chair at this time. PS asked for
nominations for the position of Deputy Chair to be forwarded to him.
5.
Date of future meetings
Friday April 8th 2011 – 12 noon to 2pm, Board and Middle
Rooms at Swift House Chelmsford, CM2 5PF
Followed by NSSG Business Meeting 1.00pm – 3.00pm
(closed meeting)
The Essex Cardiothoracic Centre, Room 3, Level D,
Basildon Hospital
sponsored by
and
(with an unrestricted educational grant)
TIME
TITLE OF PRESENTATION
9.00
PRESENTER
Coffee and Biscuits
09.30
Welcome
Professor P. Sauven
09.40
Management of Breast Cancer in the Elderly
Neil Rothnie
10.20
HER2 Availability Audit
Khalid Al-Janabi
11.00
11.15
Refreshment Break
Bolero 2 Research Clinical Trial
David Rich, Novartis
11.55
Closing Remarks and Audit Proposals for 2011
Professor Paul Sauven
12.15pm
LUNCH
1.00pm –
3.00pm
NSSG Business Meeting – Closed Meeting – Agenda to follow
For more information please contact
Sue Maughn, Interim Network Director,
Essex Cancer Network (tel. 01245 397647).
If you plan to attend, please e-mail:
[email protected]
Appendix 3
Summary Attendance at Breast NSSG 2010/11
Name
8.10.2010
NSSG
%
Title
ORG
Admin Manager
Consultant Surgeon
Consultant Surgeon
Consultant Oncologist
CHUFT
CHUFT
CHUFT
CHUFT
CHUFT
CHUFT
N
Y
N
N
N
app
0
100
0
0
0
0
Khalid Al-Janabi
Carolyn Ollenbuttel(Teresa
Dearson-Alternate)
Neville Davidson
Karen Hull
Kathy Rooke
Reggie Inwang
Consultant Pathologist
Breast care Sister
MEHT
MEHT
Y
Y
100
100
Consultant Oncologist
Service Manager
Research Sister
MEHT
MEHT
MEHT/CHUFT
MEHT
Paul Sauven( chair until
31.12.10)
Simon Smith
Roger Whitney
Consultant Surgeon
North East Essex
Pat Budd
Mr. S. Chandra Sekharan
Rebecca Elvin
Angela Haigh
Simon Marsh
Phillip Murray
Mid Essex
N
app
app
0
0
0
0
100
MEHT
Y
N
Y
0
100
Y
Y
Y
100
100
100
100
100
100
0
Consultant Surgeon
Consultant Radiologist
MEHT
MEHT
Consultant
Consultant
Consultant
Consultant
Surgeon
Oncologist
Oncologist
Surgeon
SUHFT
SUHFT
SUHFT
SUHFT
Consultant Radiologist
Consultant Radiologist
Consultant Oncologist
SUHFT
SUHFT
SUHFT
SUHFT
Y
Y
Y
N
app
BTUHFT
BTUHFT
BTUHFT
app
N
Y
0
100
app
Y
0
100
South Essex - Southend
Emma Gray
Wendy Ella
Anne Robinson
Neil Rothnie (chair from
1.1.11)
Asha Eliti
Tagreed Toma
Colin Trask
Anne McPherson
South Essex - Basildon
Karen Duncombe
Jackie Gibson
Mr. A. Salih
Service Manager
Consultant Surgeon
User Representation
Nazira Visram
Sharron Beesley
User rep
User rep
Cancer Network
Sue Maughn(from 1.6.2011)
Tom Carr
Netty Wood
Network Director
Medical Director
Network Pharmacist
ECN
ECN
ECN
N
N
N
0
0
0
Manager
ECRN
Y
100
Essex Cancer Research
Network
Ashley Solieri
Entries in Blue are Core Breast MDT members
Appendix 4
Essex Cancer Network – Agreed Breast Cancer Trial and Recruitment Accrual 2010/11
Trial Name and
Short Description
Southend
10/11
Total
Basildon
09/10
Total
ACHEW ARTemis / Avastin Randomised Trial with neo-adjuvant chemotherapy
5
5
Azure Bone Study / Bone health in Br Ca Survivors following adj Bisph
11
14
BBC-NCRN / British Breast Contralateral study
17
408
Chelmsford
09/10
Total
8
8
18
BORIS / Novel biomarkers of chemotherapy efficacy
0
09/10
Total
2
3
209
1394
37
64
58
BORIS / proteins CTCF & BORIS in breast samples
Glacier / National study of the genetics of lobular carcinoma in situ
Colchester
69
IBIS II / Prevention + Bone
2
61
6
34
IBIS II / DCIS
2
9
2
6
3
39
3
17
Icicle / Genetics of in situ carcinoma of the ductal subtype E
11
Import High / Dose escalated intensity modulated radiotherapy
0
Import Low / Intensity modulated and partial organ radiotherapy
*Complete / A Randomized, Open-Label, Phase III Study of Taxane
Based Chemotherapy with Lapatinib or Trastuzumab
*NCRN070 Vinflunine / Phase III study of vinflunine plus capecitabine
versus capecitabine alone
*NCRN81 / A Randomized Double-blind Placebo-Controlled Trial of
Neratinib (HKI-272) After Trastuzumab
*NCRN098 / BOLERO II - A Randomized Placebo-controlled DoubleBlind Study of Everolimus in Combination with Exemestane
Neo-Comice / Establishing the Efficacy of Advanced Semi-automated
Functional MR Imaging
26
Neo Excel / pre-op exmstn or ltrzl +/- clcxb
Persephone / Duration of Trastuzumab with chemotherapy in women
with early stage breast cancer
POETIC / Trial of Perioperative Endocrine Therapy
REACT / A phase III multicentre double blind randomised trial of
celecoxib versus placebo
SOFEA / Faslodex with/out concomitant Arimidex vs Exemestane
51
0
83
2
2
3
3
3
12
2
2
0
3
3
1
1
1
4
0
2
4
4
10
12
6
7
9
9
3
12
1
6
3
29
In set
up
1
2
18
1
1
0
1
Supremo / chest wall irradiation in intermediate risk breast ca
5
12
0
1
2
TNT / Carbpltin vs dctxl ER- PR- AND HER2- patients
4
5
0
9
0
1
ZICE / Zoledronate versus Ibandronate Comparative Evaluation
6
29
0
13
2
12
*Commercial study
0
1
Appendix 5
Breast Clinical Lines of Enquiry - ECN
(Nationally available Data)
1.
Rates of immediate breast reconstruction among English Cancer Networks
Taken from: The National Mastectomy and Breast Reconstruction Audit; A national audit of provision and outcomes of mastectomy and breast reconstruction surgery for
women in England Second Annual Report 2009
Data from The National Mastectomy and Breast Reconstruction Audit 2009
2.
Ratio of mastectomy to Breast Conserving Surgery (BCS)
Mastectomy and Breast Excisions (Breast Neoplasm)
Number of Procedures & Ratio of Procedures by Network (of Postcode of Trust) & Trust
Procedure Based Analysis (Between 1st April 2009 and 31st March 2010)
Number of Procedures
Network Of Trust PC
Essex
Essex Total
Proc L1
Trust
Basildon and Thurrock University Hospitals NHS
Foundation Trust
Essex Rivers Healthcare NHS Trust
Mid Essex Hospital Services NHS Trust
Southend University Hospital NHS Foundation Trust
Mastectomy
32
82
207
95
416
Data from NATCANSAT
Other Excision of
Breast
Grand
Total
72
213
155
260
706
104
295
362
355
1,122
Ratio
Mastectomy
%
31%
28%
57%
27%
37%
Other Excision
%
69%
72%
43%
73%
63%
3.
Each surgeon managing at least 30 new cases per year
Mastectomy and Breast Excisions (Breast Neoplasm)
Number of Procedures & Ratio of Procedures by SHA & Trust
Procedure Based Analysis (Between 1st April 2009 and 31st March 2010)
(Multiple Items)
Breast Neoplasm
Mastectomy or Other Excision Only
Proc L1
Diag L1 rev
EPIKEY
Count
GMC N
7179
7078
7302
7258
7124
6949
1258
Trust
Basildon and Thurrock University Hospitals NHS Foundation Trust
Basildon and Thurrock University Hospitals NHS Foundation Trust
Basildon and Thurrock University Hospitals NHS Foundation Trust
Essex Rivers Healthcare NHS Trust
Essex Rivers Healthcare NHS Trust
Essex Rivers Healthcare NHS Trust
Mid Essex Hospital Services NHS Trust
6119
Mid Essex Hospital Services NHS Trust
1
6149
Mid Essex Hospital Services NHS Trust
3
6696
Mid Essex Hospital Services NHS Trust
3
6160
Mid Essex Hospital Services NHS Trust
4
6875
Mid Essex Hospital Services NHS Trust
8
6806
Mid Essex Hospital Services NHS Trust
11
6796
Mid Essex Hospital Services NHS Trust
23
7375
Mid Essex Hospital Services NHS Trust
61
7307
Mid Essex Hospital Services NHS Trust
74
Note 1: there are a number of surgeons
who appear to be only performing 1 or 2
procedures – it is possible that this may
YEAR
2009-10
28
50
26
78
135
82
1
be due to coding issues. Not all surgeons
with numbers at a particular Trust have
been red ragged – this is because they
may be operating at more than one Trust
and NATCANSAT have used the
aggregate numbers to flag red.
7043
Mid Essex Hospital Services NHS Trust
84
7048
Mid Essex Hospital Services NHS Trust
89
113
Southend University Hospital NHS Foundation Trust
1
2652
Southend University Hospital NHS Foundation Trust
1
3424
Southend University Hospital NHS Foundation Trust
1
4401
Southend University Hospital NHS Foundation Trust
1
5509
Southend University Hospital NHS Foundation Trust
1
Southend University Hospital NHS Foundation Trust
62
7210
Southend University Hospital NHS Foundation Trust
76
7260
Southend University Hospital NHS Foundation Trust
79
7455
Southend University Hospital NHS Foundation Trust
133
4.
Average length of stay for breast cancer :
Mastectomy and Breast Excisions (Breast Neoplasm)
Average Length of Episode by Network (Postcode of Trust) & Trust
Procedure Based Analysis (Between 1st April 2009 and 31st March 2010)
2009-2010_v13
YEAR
Diag L1 rev
Avg_LoS
Network Of Trust PC
Breast Neoplasm
Proc L1
Mastectomy
6.5
Trust
Basildon & Thurrock NHS FT
Other Excision of Breast
Grand Total
2.49
3.72
Essex Rivers Healthcare NHS Trust
3.85
2.22
2.67
Mid Essex Hospital Services NHS Trust
6.29
0.82
3.94
Southend University Hospital NHS Foundation Trust
4.28
1.07
1.93
5.37
1.5
2.93
Essex Total
Data from NATCANSAT
5.
The one-, three- and five-year survival rates
1996-00
Area
code
Area
(PCTs,
CNs
and
SHAs)
EN
England
N38
Essex
1997-01
Area
code
EN
England
N38
Essex
1998-02
2000-04
2001-05
2002-06
DSR
ll
ul
DSR
ll
ul
DSR
ll
ul
DSR
ll
ul
DSR
ll
ul
DSR
ll
ul
DSR
ll
ul
93.7
95.1
93.6
94.3
93.9
95.9
94.0
95.8
93.9
95.1
94.2
96.6
94.3
95.7
94.2
95.0
94.5
96.5
94.6
95.6
94.5
94.8
94.7
96.3
94.9
94.9
94.8
94.2
95.0
95.7
95.1
95.4
95.0
94.7
95.2
96.1
95.4
95.4
95.2
94.7
95.5
96.2
1994-98
Area
(PCTs,
CNs
and
SHAs)
1 year survival
female
1999-03
1995-98
ll
ul
84.2
83.9
84.4
84.5
83.1
85.9
DSR
1996-00
ll
ul
84.9
84.6
85.1
86.0
84.6
87.3
DSR
3 year survival: Females
1997-01
1998-02
ll
ul
ll
ul
1999-03
ll
ul
85.7
85.5
86.0
86.4
86.2
86.6
87.0
86.8
87.2
87.4
86.1
88.6
88.1
86.9
89.3
88.5
87.3
89.7
DSR
DSR
DSR
2000-04
ll
ul
87.5
87.3
87.7
88.8
87.6
90.0
DSR
ll
ul
88.1
87.9
88.3
88.5
87.3
89.7
DSR
1994-98
Area
code
Area
(PCTs, CNs and SHAs)
EN
England
N38
Essex
5 year survival: Females
1996-00
1995-99
1997-01
1998-02
DSR
ll
ul
DSR
ll
ul
DSR
ll
ul
DSR
ll
ul
DSR
ll
ul
78.4
78.1
78.7
79.2
79.0
79.5
80.3
80.1
80.6
81.2
80.9
81.4
82.0
81.7
82.2
78.8
77.2
80.4
80.3
78.8
81.9
82.1
80.6
83.7
83.2
81.7
84.7
83.5
82.0
85.0