Endocrine Advisory Group Meeting 2 September 2003

Endocrine Advisory Group
2 September 2003
Green Room
Velindre NHS Trust
Mr D Scott-Coombes
Dr C Evans
Mr M Foster
Mr S Ghosh
Mr P Holland
Mr A Masoud
Mr H Morgan
Dr L Moss
Dr P Laidler
Prof J Lazarus
Dr M Page
Mr J Rees
Mr S Shering
Ms H Trotman
Consultant Biochemist
Cardiff and Vale NHS Trust
Consultant Surgeon
Pontypridd and Rhondda NHS Trust
Consultant Surgeon
Gwent Healthcare Trust
Consultant Surgeon
Gwent Healthcare Trust
Consultant Surgeon
North Glamorgan NHS Trust
SE Wales Cancer Network Manager
Consultant Oncologist
Velindre NHS Trust
Consultant Pathologist
Cardiff and Vale NHS Trust
Consultant Physician
Cardiff and Vale NHS Trust
Consultant Physician
Pontypridd and Rhondda NHS Trust
Consultant Radiologist
Cardiff and Vale NHS Trust
Consultant Surgeon
Bro Morgannwg NHS Trust
Nurse Specialist
Velindre NHS Trust
Apologies for Absence
Mr K Shute
Mr G Pritchard
Mr R Williams
Dr M Varma
Mr Lodhi
Mr Lewis
Dr S Hanna
Mr R Jones
In attendance:
Mrs J Morris
Deputy Project Manager, CaNISC Project
1. Notes of the Meeting 3 June 2003
The notes of the meeting held on 3 June were accepted as a true record.
2. Matters Arising
BTA Guidelines
Dr Moss asked for clarification of the agreement reached at the meeting regarding
referral to an oncologist. It was accepted that all new patients should be notified to the
oncologist, and all patients with a tumour greater than 10mm should be referred. This
did not preclude a surgeon referring patients with a tumour of less than 10mm.
Mr Scott-Coombes referred to a letter received from Dr Leslie Williams, Consultant
Radiologist at Velindre. It was agreed that he write to Dr Williams to apologise and
assure him that his contribution had not been ignored, but that initially he had been
unclear as to who was involved in the service in SE Wales.
3. All Wales Dataset for Thyroid Cancer
The Chairman welcomed Mrs Jenny Morris, Deputy Project Manager for the Cancer
Information Framework. Mrs Morris gave a short background to the project and to the
development of the CaNISC system. She explained that a series of pilot sites had been
developed to start collecting the dataset for specific cancers, and to share this and other
clinical information between all members of the MDT.
Head & Neck cancers formed part of Phase 2 of the project, but it had been pointed out
by Dr Moss that thyroid cancer was not adequately covered in the head & neck dataset.
Mrs Morris was therefore looking for advice as to what data items were required, and
whether it should form a separate dataset.
Following a discussion, it was clear that the group favoured a separate thyroid dataset
as the key clinical aspects and management of this cancer differed greatly from head &
neck cancers. It was proposed in the first instance to look at the datasets in use at
Guy’s & St Thomas’ and at Newcastle to see if they could form a model for the
development of an all Wales dataset. Mr Scott-Coombes agreed to liaise with Mrs
Morris on this.
4. Thyroglobulin, rhTSH and cancer follow-up
Dr Evans questioned whether there was an agreement over the criteria used to discuss
which patients should receive thyroglobulin or thyroxin. There were in particular,
concerns over false negatives.
Mr Scott-Coombs noted that the British Thyroid Association (BTA) guidelines
suggested measuring a non-stimulated thyroglobulin in follow-up. Professor Lazarus
pointed out that US evidence pointed to a place for rhTSH.
Dr Moss was unsure whether a change in practice would lead to a major improvement
in patient care, but suggested there may be benefits in more regular imaging of patients
with antibodies. She was currently using rhTSH on a patient-by-patient basis after
contacting the Drugs and Therapeutics Committee, and patients were very pleased with
their quality of life after withdrawal from thyroxin. She felt that word would spread,
but blanket use would have major cost implications.
It was agree to maintain current practice, but to keep it under review.
5. Multidisciplinary Meetings
Dr Moss explained that the revised All Wales Standards were likely to suggest that
there should be a Multidisciplinary Meeting (MDM) at least fortnightly. She
questioned whether there was an opportunity to establish a South Wales wide MDM.
Mr Scott-Coombes felt that, as there were so few patients, such a meeting could be
impractical. Mr Ghosh wondered whether a monthly meeting at UHW, with other
presenting cases via teleconferencing links, was possible. The problem with this was
that many cases would have to be discussed retrospectively, although there were
educational benefits of this.
It was proposed that a S E Wales wide Multidisciplinary Team (MDT) be established,
and that an agreed series of protocols could act as a proxy for an MDM (as happened
currently with malignant melanoma). These protocols would be audited annually, and
the results discussed at an annual meeting of the MDT, where the protocols would be
reviewed. It was agreed that Mr Scott-Coombes would write to Professor Malcolm
Mason, Chairman of All Wales Standards Group, to discuss the suitability of such an
It was also agreed that an annual educational meeting of the MDT should be
established, open to specialist registrars from all appropriate disciplines.
6. Any Other Business
6.1 Prof Lazarus reminded members of the forthcoming meeting of the European
Thyroid Association in Edinburgh, and a meeting in Newcastle on October 17.
6.2 It was proposed that the following issues should be discussed at future meetings:• possibility of centralising treatment of medullary cancers
• protocol for pre-operative staging
• referral guidelines
6.3 It was agreed to share e-mail addresses amongst members of the group
7. Date and Time of Next Meeting
The next meeting would be held at 3.30pm on Tuesday 20 January 2004, in the Green
Room, Velindre Hospital.