Rip Off Britain

Did you watch it?  I did warn you I’d be on your tellybox.

Rip Off Britain: Holidays, Episode 4 featuring lots of lovely people and me.

The piece I was asked to be involved in was with reference to the high cost of travel insurance for people with long term conditions.  It’s not just the high price though.  What we wanted to do with this story was highlight that often people don’t know their current travel insurance no longer covers them, or that their premiums will now be absurdly and often inequitably high, even if they’re many years post-diagnosis (as I am).

We also wanted to demonstrate that there are companies who will treat you as an individual, assess your case and provide a quote personal to your circumstance, holiday destination and health. I am so pleased Fiona Macrae of InsuranceWith was also featured on the same programme.  I was fortunate to meet Fiona at a time when I finally thought I’d best not travel anymore without insurance and discovered their personal approach and in turn an affordable cover.

I also hope that this feature may provoke discussions between individuals and their insurance companies to get some of the bigger companies who don’t ‘personalise’ insurance to become better at making the assessments of if they’re unable to offer ‘realistic’ travel insurance then simply not to offer it at all and to direct people to other companies who do offer it.

I’m personally pleased that the BBC also kept in mention of Phyllodes, not only verbally but also as I typed it into my computer.  Odd perhaps to be pleased with this but I was once told I was unique in my diagnosis and felt alone.  Since then I have met hundreds of others around the world (online and in person) who’ve also been diagnosed with Phyllodes and also felt alone.  I can guarantee someone looking at Rip Off Britain today doesn’t feel quite as alone as they did yesterday.

Anyway, I shall leave you to decide if I did the story justice.

Genetic Testing

In August 2011 one of my co-administrators in the Phyllodes Support Group posted in the group a request for 1,000 people who had been diagnosed with sarcoma to be part of a sarcoma research project on 23andMe.  The project was sponsored by 5 charities, Beat Sarcoma, Sarcoma UK, Association of Cancer Online Resources, Sarcoma Foundation of America and Sarcoma Alliance.  The aim was to genetically test 1,000 people who’d already been diagnosed with a sarcoma and see if this testing would find a link between us all.

A spit sample with the aim of producing a valuable research outcome that may help thousands of others in the future.  Of course, I registered immediately.

As part of the testing process each participant received their genetic test results free of charge.  I’d never considered having genetic testing so for me the test results were an added bonus.

Between my spit sample being collected by a DHL courier (who looked horrified when I had to declare the content of the package being sent to the US), and my receiving the results I found myself wondering what I would find out, whether I should even read the results, what I would do IF it told me something I’d not like to know.

At the time in the UK the process for genetic testing was to be referred by your Dr and to have counselling as part of the test.  The counselling is carried out before, during and after your test results to ensure you’re able to cope with the results and what you would do should they not be what you expected.

However as I was participating in a project run via the US, counselling was not offered and I’d not thought it would be of concern when I signed up.

Me being me, decided that I should do my own ‘counselling’ and, as far as I’m able, ensure that I’m in the best mental state to manage any results – good or bad.  I made myself consider what it would be like if I opened the email to discover that I was high risk of an illness, what I would do, who I should tell etc.  I made myself not only consider it but imagine that was the result.  I needed to know how I’d cope and what I would do in those circumstances.

So when I received an email “Your 23andMe Results are Ready!‏”, I felt prepared.  Although I confess to not opening the email for an hour or so whilst I paced and reconsidered what I’d do.

I was fascinated when I opened up the results.  How could a little bit of spit identify that I had blonde straighter hair on average, blue eyes and if a smoker, likely to smoke more!  All correct although I’ve now not smoked for years.

Within Disease risk, I discovered that I’m slightly higher at risk of coronary heart disease, ulcerative colitis, breast cancer, celiac, Crohn’s and Lupus.  But these are all relative.  On most of them I’m only very slightly higher and still it’s only 0.5% chance where the average population is 0.2%.   I can see however that one might read that as over twice the risk of the average population rather than 99.5% risk of NOT having the disease.

With all statistics and numbers it’s difficult to interpret them without emotion and to understand percentage risks in a way that’s meaningful.

I was however angry when I read my results for multiple sclerosis.  Mum had MS and my Aunt was diagnosed after Mum in the early 90s.  I remember Mum telling me that as MS is something that generally passes down the female line, according to her Dr I had now a 50:50 risk of being diagnosed with MS.  I’ll admit that this has weighed heavily on my mind since then and has infuenced decisions I’ve made in my life.  One of my school friends, Belinda, was diagnosed in her 20s with MS and passed away a few years after diagnosis.  And I’ve watched Mum become less able and eventually pass away from MS.  So when the results of my 23andMe genetic testing indicated that my risk of being diagnosed with MS was less than the average population, I was livid.  I was furious that I’d spent 25 years worrying about it.  Every time I had numbness or tingling in my fingers and toes, when my eyesight was playing up and many other ‘symptoms’, I’d wondered if it was the start of MS.  Ironically over the years I’ve never thought that they could have been wrong… 25 years ago they knew far less than they now know!

So what else did my results show me?  Actually I’m quite healthy!  For the most part I’ve a typical result or one that isn’t far off the average population.  I also know I have an increased sensitivity to Warfarin… so should I ever be prescribed this, I will know to tell the Dr that I need a decreased dose!  Nothing of note within my Carrier Status.  Only disease risks that are more than double the average population are melanoma (3.6%), celiac (0.7%) and lupus (0.5%)… but they’re still only very small percentages so I’m not going to worrry about them.

Since my first registration I’ve received regular updates from 23andMe when new research comes to light and my results are re-assessed.  I’ve been fascinated to read them.

Within 23andMe you are able to link your results to others and many of us from our Phyllodes Support Group who took part in the trial have done this.  We thought it may be interesting to see if there were traits/risks that we could identify between our small cohort group.  Sadly we couldn’t see anything that stood out with the exception that many of us had higher than average auto-immune disease risks.

So why this post now?

23andMe have just launched in the UK.  This means that anyone is able, for a price, to obtain their own genetic testing via 23andMe and without genetic counselling.  It’s a service accessible via the internet.

Germany are considering 23andMe being available there.  This week I was asked my views on it and asked to record a piece for their TV channel ZDF.  You can see it here from about 4.10.

Inevitably there’s been lots of discussion about whether it’s a good thing.  Whether genetic testing should be allowed without counselling?  Whether the results provided by 23andMe are accurate enough and using up to date data?  My view, is ‘Yes’ but with caution.  Anyone undertaking genetic testing needs to consider why they’re doing it.  What they want to know/understand from the test results.  How they’d deal with the results being good or bad.  Who they’d tell.

I wouldn’t have had my genetic testing carried out were it not for the Sarcoma Community Project.  However I’m pleased I did.  I feel I know more about myself, my health and my risks than before.

 

Art Exhibition – The People Who are Keeping Me Alive

Many months ago one of our PPI Clinical Trials group at Imperial Cancer Research, Rina, presented to us an idea.  Rina was super excited and you could see such animation and fun when she explained what she was thinking of.  Rina was also so clearly passionate about demonstrating that during her care and treatment for cancer she had been looked after by so many staff.  As Rina said we often only talk of our consultant or nurse during treatment but there are in fact so very many others who have looked and continue to look after us.  The receptionist, the phlebotomist, radiographer, radiologist, surgeon, anesthetist, appointment maker, chemo nurse, clinical nurse specialist, research nurse, porter, scientist, cleaner, hospital catering team, etc etc.  In fact Rina was able to name so many not only by title but by first name I, for one, was terrifically impressed!

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Rina wanted to honour those who had been keeping her alive.  She wanted to show the world that there were so many more involved than just her surgeon or nurse.  She wanted to demonstrate that they all had names (not just titles) and also that they had passions and loves outside of the environment that she knew them, ie the hospital.

Tonight was the launch party for the exhibition.  A time when all those of us to see the idea become a reality.  For Rina to be able to get her ‘team’ in one location and say “Thank you for keeping me alive”.

Clinfield 2014

The exhibit is kindly sponsored by Cancer Research UK and will be on display at The Cancer Research UK Imperial Centre in South Kensington until the end of November.  If you’re in London, do make time to visit.  More info – here

Because of Rina’s exhibition, Cancer Research UK have launched a campaign on twitter for YOU to nominate your hero.  Who was your hero?  Nominate them using #RinasHeroes and @CR_UK.

Clinfield Conference – speaking!

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The Clinfield Conference provides an opportunity for research nurses, allied healthcare professionals and all research practitioners to get together in a formal setting.  The Conference programme is put together with care to provide sessions to share good practice, things that worked and didn’t work, speakers talking about their career development pathway, patient advocates talking about their experience with research and how they can assist the researchers, debates and also invaluable time for networking.

I have previously been invited to attend this Conference twice by Kelly, who also leads our PPI Clinical Trials Group at Cancer Research Imperial.   In April this year I received an email, from Kelly, asking if I would like to do a session, as a patient voice, for either a panel or a debate on the use of social media for recruitment to clinical trials.  Of course, I said ‘yes’, put it in my diary and forgot all about it!

Conference Agenda

09:30-10:00 Registration

10:00-10:10 Welcome Professor Janice Sigsworth

10:10-11:00 Why clinical trials and the people who run them matter. Key Note Speaker: Mr Charles Sabine

11:00-11:15 Inspiring the next generation through student placements.  Mary Harrison

11:15-11:45 Coffee

11:45-12:45 The Great Debate:  The use of social media enhances dissemination and engagement in clinical research.

Chair: Gordon Hill Debaters: Teresa Chinn- We Nurses, Matt Ballentine, Dr Les Gelling- REC Chair, Anna Wallace- Patient Representative

12:45-13:00 Considering a Masters in Research? My experience so far. Stuart Gormley

13:00-14:00 Lunch

14:00-14:25 Stratified Medicine:  the challenges and ethical dilemmas genetic testing brings to research.  Professor Martin Wilkins

14:25-14:45 Can I retweet please? Health research recruitment and the Twittershpere. Professor Heather Skirton

14:45-15:15 Coffee

15:15-15:30  Regret in patients with acute and chronic conditions recruited to stem cell clinical trials Katrine Bavnbek

15:30-15:45  Beyond Research Delivery to Design and Dissemination- Extending the Role of the Research Nurse Caroline French

15:45-16:00 Closing Remarks and Award Presentations Professor Christine Norton and Kelly Gleason

The whole conference was inspiring but none as moving as Charles Sabine’s presentation.

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Charles spoke candidly about his career as a TV journalist where he spent many hours and years reporting from war-torn parts of the world.  No doubt an incredible career and something that few of us would be brave enough to do.  But then he spoke about something way braver than his time in journalism.  He had the whole audience hanging on his every word and, at times, wiping a tear away.  Charles’ father was diagnosed with Huntington’s disease (AKA HD).  He watched as his father ‘disappeared’ before his eyes.  From an intelligent, articulate and ‘alive’ man, he became reliant on others for everything.   HD is a progressive and hereditary disorder for which there is currently no cure.  Charles and his brother have had genetic testing and both tested positive.  Charles’ brother, John, an incredible successful lawyer, is now battling this fast moving and progressive disorder.  For the moment, Charles has no signs.

Charles, like so many of us when we are told ‘there is no cure’ ‘there is no research’ or ‘you’re unique’, uses his experience in journalism and as a son, brother and person affected by HD to a different use.  He is now a spokesman for freedom of scientific research, and sufferers of degenerative brain illnesses (including HD).  He has been talking about his experiences at conference such as this, raising awareness, rallying and organising groups of people affected by HD to speak up and get involved.  He spoke of HDBuzz, Huntingdon’s Research News.  He also spoke about The Huntington’s Disease Youth Organisation (HDYO) where younger people diagnosed with HD are able to get together in person, online, via social media to support one another but also to push for changes and research.

Charles’ presentation without any hesitation was moving.  I wasn’t familiar with HD.  I am now.  But what I also see is the impact that a patient voice (albeit one from the tellybox) can have on improving awareness, patient care, support and, the everso needed research.  Charles’ experience with HD is similar to other rare conditions and diseases and what Charles demonstrated was that by using social media, by using our voices we CAN make an impact.  Research may not be within our lifetime nor may it make a difference to our own health but to KNOW that we  have made a difference for future generations and that, particularly in the case of hereditary disease, our children or grand-children will have the benefit of our involvement now.

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I felt for Mary Harrison, the next speaker on the podium.  How could anyone possibly follow Charles’ presentation?  She did, brilliantly.

Mary is clearly passionate about encouraging and enthusing the next generation.  About engaging all new students in research so that it becomes part of their ‘everyday’ no matter which medical field they end up in for their career.  Research should be second nature to consider for each and every person, patient and non-patient.  Without research medical advances cannot be made.  Healthcare improved and a better and longer quality of life gained.

It was wonderful to hear some of the initiatives and working methods that have been implemented and that Mary is championing.  I hope that others attending the conference were able to go back to their workplaces and implement similar projects.

10690252_790103731037931_4089365723065417337_nAfter a short coffee break, it was time for the Great Debate: “The use of social media enhances dissemination and engagement in clinical research”.  I was on the stage!  We had four debaters, 2 for the motion and 2 against.  My job was to debate against the motion.  The chair for this session, Gordon Hill, introduced the debate and asked for a show of hands for and against the motion.  There was one lonely hand waving ‘against’.

10687141_790104117704559_3378078328530090806_n10421999_790103884371249_2477100869151685393_nTeresa Chinn, @WeNurses, presented her arguments FOR the use of social media.

Compelling arguments and we could see a great deal of nodding from the audience.

Dr Les Gelling @Leslie_Gelling was first to present his arguments against.1932271_790103911037913_2057804842392007702_n

Again I looked out at the audience and saw nodding and acknowledgement of the points Les raised.

10351655_790103937704577_40107761402128731_nMatt Ballantine @ballantine70 stood next to argue FOR the usual of social media.

 

1538625_790103957704575_6793728141737878822_nLast to speak was me.  I questioned if you could really engage people with 140 characters and provide enough information for them to make an informed choice.  I queried the use of acronyms to reduce the character size reminding the audience that patients and carers don’t yet know what these acronyms mean.  I was also able to mention ‘Phyllodes’ in my short presentation 3 times… hehehe a room full of researchers have now heard of our rare cancer!

Without a doubt the debate was difficult.  All four speakers are active users of social media and see the value of the medium for dissemination of information.  Les and I had discussed before the debate how it was difficult to sound passionate about  an argument you didn’t believe in.

In the summing up, Les did a wonderful job of putting doubt into the audience’s mind.  About ethics, confidentiality, understanding, interpretation and audience.

1486625_790104004371237_6015179206767551081_nThere were some very interesting questions from the floor and even some examples of where the use of social media had worked already.  Namely when recruiting young mothers to a trial via MumsNet.

Finally a show of hands from the audience to see who was now FOR and AGAINST the motion.  Les and I had won the debate – there was now no longer a lonely arm waving but a large number in agreement with our arguments.

I must admit to despite winning the argument feeling a little disappointed.  I am in favour of the use of social media for dissemination of information.  However what was highlighted in the arguments and questions was that perhaps we’re not quite there yet.  Not everyone feels comfortable with social media.  Not everyone uses it.  We’re not yet au-fait with using social media effectively nor do we know the true impact of using it.  Social media is still in its infancy and as such there is still a great deal to learn.

It should be something that is used for some aspects now.  It is somewhere that we can learn more and engage and encourage people to become active in research.  It is somewhere that can clinical research trials can be advertised or links to recruitment programmes be discussed.

I think the debate was wonderful as it clearly made the audience think more closely about their use of social media.  It will hopefully mean that it can be used as ‘part of’ a recruitment project but with consideration for confidentiality, ethics and understanding.

 

The afternoon sessions at the conference were fascinating.  It was wonderful to hear from various people about their passion for research, inclusion, consideration of patient side effects and quality of life but mostly about the willingness to share with others their experiences (good and bad).  I know that all those attending this conference will have left with a new understanding of some aspects of research and I’m quite sure many will have been implementing changes or looking at the way they’re currently operating to improve the research landscape.

I’m passionate about research.

It should be part of everyday conversation.

Sadly most of us only think about research when we or a loved one is ill.

Research is also conducted on people who are well with the use of surveys, spit or blood samples.

Research doesn’t have to be invasive or require the taking of medication.

YOUR involvement in research could make a difference in the future.

Tower Poppy Removal Team

I was pleased as punch when I received notification that I had been allocated a shift as a volunteer on the Tower Poppy Removal Team.

Tower Poppy Removal1I had been so incredibly moved when I visited the Poppies in September.  The representation of all those who lost their lives during WW1 by a sea of vivid red ceramic poppies.

Each poppy being planted one by one to create a beautiful and temporary remembrance.  The Tower of London Poppies has become a ‘destination’ for so many visitors from overseas but also around the UK.  So many photographs being displayed on social media and in the press.  Now, as was intended to display the fragility and temporary nature of life, the exhibit is being carefully plucked from the earth one by one, dismantled, washed and packed up dispatch.

The role of volunteer was fun, a small fun team within a large volunteer group working around the moat.  Trying hard to not chip or break each poppy whilst removing the washers and stoppers that had held the flower in place so well.  Our little team removed poppies first and then changed duties to separate the washers, rods and stoppers.  Other teams were on cleaning duties and others packing the poppies into boxes.

Tower Poppy RemovalIt didn’t go unnoticed amongst our team of volunteers that our task was also incredibly moving once again.  I was acutely aware that with every poppy we were removing it represented someone loved and lost.  There was also the feeling that we were handling the ‘last remains’ of those people and that they were being dispatched to the loved ones left behind.

Truly an honour to have been part of such a moving and beautiful remembrance tribute.

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A novel way to celebrate 5 years since diagnosis

When Greig Trout, the author of 101 Things to do when you Survive, messaged me to let me know he’d nominated me to take part in a BBC documentary, we had no idea that the filming would take place today, my cancerversary.

I’ll be honest and say that I have been more than a little nervous about doing it at all and the idea of ‘putting myself out there’ for all to see on the tellybox has induced more than a few sleepless nights.  Greig had been asked to do the show and would, no doubt, have been brilliant.  But the lure of more travelling, proving there is life after not one but two cancer diagnosis, inspiring others and raising awareness was too great for him and he jumped on a plane to Broome in Australia instead!

I can’t explain too much about today’s filming as the BBC want, of course, to have an impact with the show when it’s aired in January.  My day started at 7.15AM when a taxi arrived to take me to the first filming location in the City of London.  Stupidly I wondered how I would recognise the team I was meeting… until I walked in to a coffee shop to see cameras and lights set up and waiting for my arrival!  (blonde moment).  Nervously I was interviewed on camera.   All the time worried about how I would look, whether I would do a good enough job and trying not to be emotional.

The next part of our day was crucial.  I was to conduct an ‘interview’ on camera.  I needed to be polite but to needle.  I needed to enquire but to listen.  I needed to ensure my questions would inform and that the answers received were useful.  I needed to be Robert Peston but hope that little old me was an OK substitute.

The final part of the day was about me and filmed at home.  ‘About me’ is never something I’ve been particularly comfortable with.  I’m usually taking the photos or choose to hide at the back of group pictures.  Unsurprising then that when asked by the BBC to find some holiday snaps of me, I had diffuculty locating ones with me in them!  Ironic to think I am spending the day being filmed!  I was interviewed on camera about my diagnosis and experience with having cancer.  Having been in control of my emotions all day, I wonder if I might seem emotionless on camera.   We also filmed me doing normal things at home, meeting a friend, juicing, writing this blog, looking at holiday photos etc.  All to set the scene about me in the documentary story and why the topic is so important to be aired.

BBC Crew(In my kitchen!)

A very long day (11 hrs) and I was exhausted and emotional by the time the crew had left.  Ironic in so many ways.  Not least that the filming was taking place 5 years on from when I heard that dreadful phrase “You have cancer”.  A milestone I marked with telling my story to camera.  Hopefully the film will achieve changes in an industry that takes advantage of those who are living with a long term condition.  Hopefully it will raise awareness of the issue and signpost those affected to the right place at an affordable price.  Hopefully it will also raise awareness to Phyllodes by the mention in the piece.  Hopefully this mention will mean that others diagnosed with this rare cancer will not feel alone and find others in the Phyllodes Support Group.  Hopefully I did the piece justice…

Let me know : Rip Off Britain being aired in January.

PS  Apologies about the ill-fitting jeans… my excuse – I’ve lost weight and got dressed in the early morning darkness!

Tower of London Remembers : Blood Swept Lands and Seas of Red

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To mark one hundred years since the first full day of Britain’s involvement in the First World war, an incredibly impressive and striking art installation called ‘Blood Swept Lands and Seas of Red‘ has been installed (and continues to be installed) at the Tower of London.

I understand that it was the imagination of ceramic artist Paul Cummins who proposed the idea and with the assistance of stage designer Tom Piper, the project is coming to fruition.

888,246 ceramic poppies, each poppy representing a British military fatality during the war, will progressively fill the Tower’s famous moat over this Summer.

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I’ve seen photographs and listened to commentary on the radio talking about the installation but truly until I arrived there on Wednesday evening I’d not realised the full extent of the impact.

The installation itself is stunning, rich red in colour, each poppy beautifully crafted and individual in it’s perfect form.  Yet together creating this image of blood pouring from the Tower into the Moat in such a striking and moving way.

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We arrived shortly before the evening’s Roll of Honour was to be read.  As we stood looking down into the Moat we listened to the Yeoman Warder reading out a list names.  Each name and rank was read with care and respect.  The Yeoman looking up at the silent group of onlookers and pausing after each name.  At the end of tonight’s long list of names of soldiers who had died too young and lost their lives fighting for our Great Britain, an officer moved up to the ‘mound’ and played the Last Post.  Each note resonated around the Moat and almost clung to the Tower before drifting off into the evening’s last light as the sun went down.  Still and solemn silence from the large group of onlookers with most of us occasionally dabbing an eye.  An incredibly moving experience and one I shall remember for a very long time.

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Since attending, I’ve now registered as a volunteer so that I can play a part in this installation but more importantly to honour the men and women who gave their lives in  World War I.

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Poppies can also be purchased here and I understand will be dispatched after Christmas 2014.  The sale proceeds are going to support 6 UK service charities.

If are in London before the installation is dismantled carefully on 11 November 2014, you MUST go to see it.

The Great Debate: Should we use social media to recruit patients in clinical research?

Eeek the Agenda has been published for the annual Clinfield Conference for Clinical Research Staff.

Guess who’s speaking and part of the panel debate? Meeee….

“11:45-13:00 The Great Debate: Should we use social media to recruit patients in clinical research?
Chair: Gordon Hill Debaters: Teresa Chinn- We Nurses, Anna Wallace- patient representative, Les Gelling- Ethics Chair”

As always it will give me the ability to mention ‘Phyllodes’ and this occasion to a room full of people at the coalface of clinical research.

As you will all know from this website social media has played a huge part in my finding other people diagnosed with Phyllodes; sharing experiences and supporting one another; researching medical/scientific papers and sharing them with the group; discovering clinical trials around the world and again sharing them with the group; and so much more.

I know that when we’ve discussed clinical trials and research within social media, the thirst for knowledge, how to sign up and get involved and interest in any results and findings from group members is enormous.

Using social media as a way to recruit patients into clinical research is a no-brainer.  It should also be used to educate and inform patients on what research is; what and how you could be involved; why it’s important for medical advancement for you and others; etc.

My ‘journey’ would have been a very different one had social media not played a part.

I’d love to hear your comments.

Strengthening public and patient engagement in biobanking – developing plan of action – Cancer Biobank Conference in Cardiff

Strengthening public and patient engagement in biobanking – developing plan of action
Masonic Hall, Cardiff – Wednesday 18th June 2014

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Sadly due to problems on the M4 I missed the introduction to the day and part of the first speaker’s presentation.

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Dr Kirstin Goldring
UCL Biobank and NIHR BioResource Coordinator
Public perception of research – where are we starting from?

Kirstin presented some of the findings from recent research as below:

Findings:

  • Majority of respondents want to take part as long as the research has been approved by the research committee.
  • Involving patients in the group helps with research and information written in a way that can be understood by the non-medics. However our research showed that patient involvement in the research project didn’t make any difference to their involvement.

Findings: Eurobarometer

  • The term “Patient involvement” was not clearly understood either by patients or practitioners.
  • But once understood what it means both practitioners and patients appreciate the involvement of patients.
  • Communication was central to the better outcomes however practitioners are aware that they perhaps don’t have the time to do this well.
  • Patients need to feel empowered to ask questions and get more involved if they need to do so.
  • Practitioners worried about giving alternatives as it may dilute the patient’s focus.
  • Chronically ill patients tend to have more awareness of treatments and self-monitoring their wellness.
    Younger patients had higher expectation of their own involvement but were more reluctant to ask questions.

Findings: The Wellcome Study

  • Participants in research showed overwhelming support for the return of health related findings particularly when a condition is treatable and serious. Feedback throughout the process.
  • Respondents valued the role of a health professional or those they already had an existing relationship with during the process.

Findings: STRATUM

  • There is a high level of public support for biomedical research and willingness to donate NHS for this purpose.
  • More information and interaction they have with the process the more people are willing to be involved.
  • There was concern about where samples may be used. It was essential to provide good consent information.

Public Perception of Research

  • Public are interested but need more information, understanding and communication… Begin the conversation.
  • PPI needs to be considered before you start the process of putting a study together. Involve patients before the study is even designed.
  • Heading in the right direct but need to keep involving, developing and evolving.

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Amir Gander
Lead, Tissue Access for Patient Benefit

  • Falling between the cracks
  • Power of patient involvement
  • Linking across many hospitals over the north and east of London together with NHSBT transplant pathway.
  • Started out setting up and putting in questions about research and consent to all patient questionnaires. This evidenced that most people would give consent but those that didn’t had a doubt as to how their tissue was being used. Simply speaking they weren’t aware of the ethics and rules.

Amir was part of the team who set up a Big Bang Fair which is the largest celebration of science, technology, engineering and maths for young people aged 7-19 in the UK.

During the Fair they were able to speak with the young people about organ transplantation and donating tissue for research.  They also set up questionnaires before and after the process to gauge option on organ transplantation and tissue.  The kids were dressed up in lab coats and participated in many ways including an interactive iPad game and an anatomical model.

What’s next:

  • Going into schools
  • Organising events in neutral locations ie football, community centres etc
  • More Big Bang Festivals
  • Take this format around the country.

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Alison Parry-Jones
Manager of Wales Cancer Bank

Introduced the next section of the conference with a slide from NCRI.

How others raise awareness and increase understanding – case studies

  • Cancer Research Wales
  • Organ Donation Wales
  • Clinical Trials in Wales
  • GE Healthcare
  • How Tenovus use social media
  • Lay / Volunteer consenting for biobanking

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Liz Andrews
Director for Cancer Research Wales
Proud to support the Wales Cancer Bank

Totally dependent on the donations that are given by the public to Cancer Research Wales.

How do they generate and raise awareness that leads to donations:

  • press releases
  • radio adverts
  • social media
  • annual open day
  • newsletter monthly
  • website blogs
  • shops
  • community events

They’re also keen to say that all money raised will be used within Wales for research.

Every January they open the doors to our research labs so that the supporters can come in and meet the researchers and have a tour of the facilities.

Cancer Research Wales have a dedicated library for cancer. It is staffed by an excellent team who are able to research and provide specific information to medical professionals, charities and organisations thereby aiding the process.

Using the monthly newsletter to include a story about the research projects. A story on the researchers which includes details on the projects but also some detail about the researcher themselves. In addition to fundraising projects and fundraisers. The emails these generate from the public is very positive.
They track all the links on the newsletter so we can see how many people read which links. This helps them to know what is important to the public.

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Pat Vernon
Welsh Assembly Government
Organ Donation Wales

There is to be an Opt-Out system for organ donation in Wales.
How do we communicate the change to the public? It’s to be implemented in 01/12/2015.

Organ Donation – why we need to think about it?
The problems – societies’ view, myths and reality

Organ donation:
… is a final act of generosity
One person can save or transform up to 9 other lives by organ donation.
The most successful and cost effective treatment for many.

We have a chronic shortage of organs across the whole of the UK

People who could donate are not becoming actual donors

High rate of family refusal to consent to donation often because we do not know what our relative wants.

People are dying waiting for a transplant – 36 died in Wales in 2012/2013 waiting for organ donations.

What’s stopping us?

  • 9 out of 10 people support organ donation in principle
  • Around 60% never discuss it or get around to doing anything about it.
  • 1m on the Organ Donor Register in Wales but what about the other 2/3rds of the population
  • Reluctant to think about death
  • Faith and culture?

Get informed about organ donation:

  • Age is no barrier
  • Health conditions may NOT preclude organ donation
  • All the major faiths support organ donation
  • Organ donation is a very rare event, 30,000 people die each year in Wales but only around 250 in the way in which donation is possible.
  • Organ donation does not affect the quality of care you are given at the end of your life.

What’s being done in Wales:

  • Changing the law to a soft opt out version. This will happen until 1 December 2015.
  • Means you’ve consented to organ donation unless they’ve said otherwise.
  • Families will still be involved and be able to say if they know their relative didn’t want to donate.
  • Expected to deliver a 25-30 increase in the number of donations or 15 additional donors… which each one could save 9 people!

Awareness raising:

  • All the things above
  • But also the two year period until it is to become fully effective. They need to understand the choices and decisions. If you want to be a donor you can make an express decision to be a donor. Or do nothing and it will be deemed to having no objection to organ donation.
  • If you DON’T want to be donor you can register as that.

Encourage people to talk about organ donation. We know that most people don’t talk to their families about these things and it’s imperative that these conversations take place

The awareness and campaigning will need to continue so that new people to Wales understand their consenting and also so that people are reminded of how they can update their wishes.

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Barbara Moore
Communications and Engagement Manager
National Institute for Social Care and Health Research Clinical Research Centre

Clincial Trials in Wales

  • Cancer Research UK funded nurses and the research body at first. It’s now funded by the Welsh Govt.
  • NISCHR CRC have research nurses embedded within the NHS staff
  • Involving people through training and also payment.

Cancer Research UK do still fund some clinical research nurses at public promotional events in Wales.

Patient understanding of clinical trials is low. A campaign that was carried out is ‘It’s OK to ASK‘.

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Alyson Ayland
PR & Organisational Communications Specialist
GE Healthcare

GE provides tools and machinery to pharma but isn’t a pharmaceutical company.

5 step approach to engagement strategy:

Vision:

  • Be clear about your strategy. What outcome are you looking for? A little like a business strategy.
  • It takes time to build relationships and they develop over time with interaction.

Mapping:

  • Prioritise stakeholders
  • Focus internally and externally so that people understand what your strategy is.
  • Partner with other organisations
  • Programme of public speaking events. Prepare a speakers toolkit and ask your supporters to advocate/speak for you.

Media

  • Your people are your best advocates. Make sure they are all informed enough to talk about it.

Tactics:

  • Launch campaigns
  • Showcases
  • Strategic partnerships
  • Site visits from MEPs and people of influence
  • Guest speakers events
  • Photo opportunities and cross pollinating events
  • Newsletters (hard copy as it stays on desks longer)
  • Personal emails and letters
  • Networking events
  • Awards

Keep looking for conversations about what you can do

Milestones:

  • Keep projects energised.
  • Have events and remind people what you’re doing and why. Space them out so that they keep momentum but not too many.
  • Visit from health minister to show and tell about products and aspirations.
  • Signing of Memorandum of understanding with the local universities. Looking for synergies and collaborations.

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Will Barker
PR & Digital Officer
How Tenovus use social media

There’s a huge amount of people using social media however there’s also a lot of noise. We need to be heard above it.

Tenovus use Facebook, Twitter, Instagram, Youtube, Vine and LinkedIN

  • Want to tell stories of people we support. This increases awareness and also share the work that we do, research , support fundraising and awareness.
  • We want to be heard. A voice of professional opinion and comment.
  • We want to be the voice of cancer patients in Wales.
  • Talk to people that matter to Tenovus in the place that they’ve chosen. i.e. those who are on FB anyway will interact without having to change location
  • Not just broadcasting it’s about having a conversation.

Social media allows your organisation to get what it wants out of it. You can choose how to use it and how to interact.

Social media is a great way to drive people to our website where we can put much more information than we can on a post or tweet.

Must represent all people. Not just pink and female!

We use videos in blogs from researchers to show the ‘face of research’ to the public. A brief introduction but then if someone is interested, they can link through to more information available to them.

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Dr Balwir Matharoo-Ball
Operations Manager, Translational Research and Biobanking, Nottingham University Hospital
Lay volunteer consenting for biobanking

New biobank in Nottingham. Set up 3 years ago.

Patient Public Involvement in Consenting for Biobanking.  The use of language should also determine the level of the patient public part:

  • Participation – You take part
  • Engagement – You’re on the periphery
  • Involvement – From start to finish involvement

The public voice is really important to learn from and why all should listen.

Process of taking consent for inclusion in biobanking should be sensitive and involve the person and family

Asking for PPI involvement, NHSB produced a job application, training by the hospital trust, give them an honorary contract from the trust and also sign a confidentiality agreement.

As they are also facing the public they need to go through the necessary checks.
The PPI advocates are also taken through the whole process full life cycle of biobanking touring the histology labs and receiving an overview of the NHSB clinical/sample storage.
Annual appraisals for the PPI advocates.
Recognise and acknowledge the number of years given to the Nottingham Uni Hospitals by the PPI advocates.

~~~~~~~~~~

We broke for lunch during which time we were entertained by a wonderful group of singers from the Tenovus Choir.

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AFTERNOON SESSION

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Dr Bridget Wilkins
Experimental Cancer Medicine Centre Network / NCRI Pathology Networking and Biobank Lead
Swipe here to donate

Would a ‘swipe to donate’ card work for signing up for giving consent to use your tissue for research?

  • Same as a loyalty card, it might be presented to the person with instructions about how to active online. Once online the person is able to personalise the card, say what they would and would not consent to. Additional information about patient groups in the area, current research studies that are local.
  • Your consent would then be added to a database and the card would be the key. Information is updated if you had a hospital episode of someone has done.
  • You could incentivise someone by doing online research or updating it regularly.

Would need to be prompted to check in and update.. perhaps by email, text or on a letter.

You could also say how you wanted to be contacted i.e. by text/email/post. This communication could be used to send additional information or new trial information.

You could also keep it updated with other information such as recent blood tests.

Record mood, wellbeing, lifestyle information, weight/height etc. Enriches the dataset of your tissue which makes it of more use to the researchers.

A simple interactive tool to volunteer our use for leftover tissue samples.

Counter-argument against swipe cards

What happens if I lose the card? Can’t remember the pin number? Website.
I’m happy you can use my tissue, don’t bother me again.
Personal information about me, how will I know it’s secure? Where is it held?

~~~~~~~~~~

To close the day there was a round table breakout session to come up with action points and an implementation plan to raise understanding and awareness of research.

  • How do you get more public awareness into biobanking?
  • What is biobanking?
  • Would you attend an open day at a biobank?
  • How can biobanks or the CCB address challenges of public engagement in biobanking?

Discussing a number of challenges:
Appropriate communications, avoiding jargon, plain language.
Unfamiliarity about biobanking.

ST – Posters in waiting rooms in GP surgeries, A&E clinics etc
Start conversations about medical research and biobanking at different levels:
School, W1, community groups, Unis, Rotary, soap opera, magazines.
Divorcing fro own personal health but being part of everyday conversation.

ST – develop toolkits to give to resources so that these conversations can be had at appropriate level, professionals, patients, general public.

Trust – make this type of complex and emotionally laden topic accessible to all, accessibility = transparency = trust. Seeing is believing – tours of biobanks.

Looking at what we can do internally within biobanks.
Getting Biobanks managers and boards to understand the difference between involvement/engagement/consultation. Involving actively or engaging passively.
Sharing best practice with case studies from biobanks.
Research studies to demonstrate the impact that public and patient involvement can have on biobanking.
CCB could set up and provide a professional program to train biobanking managers on how to to do it, engage, involve. As part of CCB membership additional ‘kite mark’. Which will also build trust and transparency.

How can the CCB most effectively translate the findings of biobank into health development.
How do you engage Govt to develop a policy? Incentive?

~~~~~~~~~~

An incredible thought provoking day discussing biobanking, tissue and organ donation and also looking at the small amount of people who actually participate and discussing why.

I hope the notes from the above may get you asking questions, perhaps signing up but more than anything having a conversation about it all and letting your friends and family know your wishes.

NCIN Conference 2014 (Day 2)

The second day of the conference began with me being fairly grumpy!  The queue to get into the dining room for breakfast was stretching out to reception!  After 20 minutes of waiting, I gave up.  I only wanted a croissant and some fruit but it wasn’t to be as I was keen not to miss any of the conference… but no breakfast = grumpy Anna!  Hilton Hotels get your act together!

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Plenary 3 – Global cancer surveillance: opportunities and challenges

Professor Julia Verne
Director of Knowledge and Intelligence Team SW, Public Health England

Plenary session in the memory of Brian Cottier (1951-2009)

1 in 3 will get cancer
1 in 4 will die from cancer

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Freddie Bray
IARC – International Agency for Research on Cancer
“World wide cancer burden”

Global cancer surveillance opportunities and challenges

Socioeconomic changes and how that impacts cancer incidence and survival.

14.1 new cases in 2012
8.2m deaths
32.5m living with a cancer diagnosis

9 cancers for majority of cancers 2/3rds of burden.

Globocan 2012 provides many graphs and examples.

The changing world – transitions
Major increases in the population coupled with increasing longevity has linked to epidemologic translations Including cancer, moving from infection related cancers toward a western lifestyle.

1 in 3 NCDs are cancers.

A great deal of information and graphs showing changes in some countries for increases in cancer and also decreases eg Japan have an increase in young people with cervical cancer. India have a reduction as marriage age is getting higher. Russia and Belarus have no screening and it has rapidly increased for cervical cancers.

Why registries are so important so we can track what is happening and measure it accordingly.

NCD agenda, of surveillance activities
Training and collaboration with cancer registries around the world. Try to ensure registries are in place to help with cancer control and also for reporting worldwide.

3 way split between high quality data, national and regional data and frequency data but 62 countries with NO data at all.

Current situation
Recognition of increasing global cancer burden.
Despite a long history of cancer registration LMIC have not developed PBCR
Link in with political agenda and tackling of NCDs

UN high level summit talks about cancer registries.
Global monitoring framework

IARC Technical Publication No 42 “Planning and developing population based cancer registration…”

Global Initiative for Cancer Registry objectives

IARC Regional Hubs for Cancer Registration in LMIC

Good data collection and methods of using and sharing data effectively.

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Dr Milena Sant
Instituto Tumori, Italy
EUROCARE 5 – survival of cancer patients in Europe

21 countries with a national registry inc 7 countries from eastern Europe.

50% of European populations including over 10m cancer cases.

Next steps for Eurocare

Reduce inequalities,
Treatment is not only solution for control
primary prevention, early diagnosis, accurate diagnosis – are all factors

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Sara Hiom
Cancer Research UK
The International Cancer Benchmarking Partnership’s Impact on Policy and Practice

What is the ICBP? – unique collaboration in terms of countries, international collaboration involving policy, research, cancer registry and clinical professionals at a global view.

13 jurisdictions in 6 countries
including Scotland for module 5

What are they looking at?

  • breast, lung, colorectal and ovarian

5 modules

  • Epidemiological benchmarking study
  • Public awareness, attitudes and beliefs
  • The role of primary care and healthcare systems
  • Variation in patient,diagnostic and treatment time intervals and routes to diagnosis
  • Data comparability and early deaths

Focus increasingly on the first year post diagnosis. Why are we not getting more patients beyond the first year survival which we can also see affects the 5 year survival statistics.

Module 1 – survival and stage table.

It’s not only early diagnosis that came out from this module and data comparison. It was also access to services and quality of treatment.

Module 2 – awareness and beliefs
Looked at differences in population. In the UK were our people less aware of the signs and symptoms?
Findings: ABC measure was born and has been used for surveying populations.
Generally speaking similar levels of awareness across all ICBP countries.
Generally low awareness across all countries of the increase factor of age.
UK – stood out the reluctance to visit a GP and wasting the Dr’s time. Elements of embarrassment i coming forward in the UK.

Be Clear on Cancer campaign to try to change the belief of wasting GP’s time or embarrassment.

Module 3 – role of primary care
Were there fundamental differences in systems?

  • Progress 2895 GPs responses to online survey and analysis complete in 11 jurisdictions.

Papers are about to be published.

Latest (unpublished) international data suggests that GPs in England:

  • Are less likely to send a patient for tests
  • Report having among the lowest access to specialist advice
  • Tend to feel more strongly about protecting their patients from over investigation and preventing a secondary care overload.

We need to look at the cost structure to overcome this aspect.

Module 4 – patient, GP and specialist intervals
Still underway…

  • Looking at via surveys patients, GP and specialist.
  • Looking at length of time between first noticing symptoms and time to GP and referral.
  • Collecting this information across the cancer pathway in 10 jurisdictions and comparing each of them.
  • Anticipated impact is focus in on areas with longest interval.

Module 5 – data quality simulation
Variations in cancer registry practices affect the comparability of key data used in cancer survival analyses

Look in much more depth of the differences in registries.

Should have a key impact on the best practices and developing tools that look at different factors.

Module 5.2 – short term mortality and co-morbidity
Not started yet…

Building on the legacy of ICBP.  Lots of questions have left unanswered but needs to continue and keep it up on the agenda. Perhaps political policy will assist keeping it on the agenda particularly as comparing with other countries.

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Reducing Health Inequalities
Chair: Dr Tony Moran
Director of Research and Intelligence (North West) at Public Health England

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Therese Lloyd
Prostate Cancer UK
Lifetime risk of diagnosed with and dying from prostate cancer in different ethnic groups

Process of finalising a publication but as yet unpublished.

What do we know?

  • 1 in 8 men in the UK will be diagnosed with prostate cancer at some stage in their life.

We know there are ethnic differences but don’t know how they translate into incidence and mortality.

Data and analysis
Few date issues that meant we weren’t always able to tell the ethnicity for over 1/4 of the data fields.
Total numbers of deaths in the data did not match up the total number of deaths in the office of statistics.

Several analyses in each ethnic group were done.
Best estimate but also larger groups to get a true value.

Used DevCan – system US.

Major ethnic groups analysed – white, black and asian.

Mixed – were difficult to obtain clear results.

Lifetime risk is calculated as percentage and odds.

Although there is a bit of variability based on the methodology used. Consistent message that Asian men (1 in 13) are at a lower risk of being diagnosed of prostate cancer than white men (1 in 8).

Black men are at a much higher risk, although much more variability the research evidences that approximately 1 in 4.

Best estimate – White 1 in 24, Asian 1 in 44 and black 1 in 12 – dying from prostate cancer.

Looked at data from 2008-2010.

When you compare the diagnose number and deaths all groups indicate that 1/3 (across board) will die once diagnosed. Perhaps there is no difference between the aggressiveness of the disease no matter what colour skin.

Need to reach out to BME communities to be aware of symptoms.

More research is needed and collection of perfect ethnicity data is needed.

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Chin Kuo Chang
King’s College London
A cohort study of mental disorders, stage of cancer at diagnosis and subsequent survival

Presentation

2011 cancers has seen the largest percentage of death in the UK accounting for 30% cause of death.
For serious mental illness it’s the 2nd or 3rd cause of death.

Big gap between the general population and people with serious mental illness (‘SMI’).

Only 1 team in WAustralia investigating this.

2 research questions (looking at data 2010-2013) CRIS
early symptoms ignored or not understood. Is the stage also affected when diagnosed.

Cancer linkage

  • Cancer register to include incidence of mental disorders
  • Trajectories of cancer treatments for ppl with SMI
  • Prognosis of cancer patients with psychiatric comorbiditiy.

Extending CRIS system to Cambriddge, Imperial – UCL, Oxford and Camden & Islington.

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Mark Rutherford
Research Associate, University of Leicester
Understanding deprivation and inequalities using loss in execution of life use to a cancer diagnosis (using only UK data)

Please refer to presentation

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Preventing Emergency Presentations – the need for research
Chair: Stephen Duffy
Wolfson Institute

We know that emergency presentation is particularly common in some cancers such as lung and bowel. Associated with a poorer outcome and may be associated with initial treatment from wrong specialist.

Emergency Presentation is more common in older people.

We need better understanding who’s at risk and what can we do about it?

Targets for today from the interactive workshop:

What are the major knowledge gaps?
What cancer sites are most promising for intervention?
What interventions are ready for evaluation?
Not simply to replace Emergency presenting with routine presentation. We want to replace with someone presenting 6-12 months before with stage 1 or 2 cancer.
Who should take this forward?
Very much in our hands as to which teams should take these interventions forward? Research fellows? Charities?

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Less Common Cancers
Chair: Jane Lyons
Cancer52

Cancer52-NCIN-Report-10-June-2014-FINAL

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Lucy Elllis-Brookes
NCIN & PHE
Setting the scene for rare and less common cancers

Presentation

Big 4 – breast colorectal lung and prostate
Less common cancers e.g. uterous, melanoma, ovary, kidney, CUP, pancreas, cervix, multiple myeloma
Rare cancers…. even more !

Screen Shot 2014-08-18 at 15.33.40Rare and less common cancers:

Screen Shot 2014-08-18 at 15.34.58

What is NCIN doing?
Routes to diagnosis – increased look at cancer types and producing data from them 22 in 2010 and 57 in 2014.

Deprivation reports – 23 in 2008 and 37 in 2014

Site specific Clinical reference group work (recent examples)

  • vulval cancer – trends and variations by age
  • kidney cancer survival report
  • penile cancer incidence by age

What do rare and less common cancers have in common?

  • Each cancer site shows different results.
  • Different analyses will be required
  • Specialist advice (clinical and analytical) is crucial.

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Oksana Kirichek
University of Oxford
Menopausal hormone therapy and risk of central nervous system tumours: a nested case – control study

Aim of study:

  • Is Hormone therapy (HT) associated with risk of brain and other CNS tumours
  • To test whether the effect of HT varies type, duration or recency of HT preparation used.
  • To assess the effect of HT exposure on the risks for all CNS tumours

GPRD General Practice Research Database

  • Holds primary and secondary data. cross linked with other databases and person specific.

Definition of cases

Results
No significant difference in risk by tumour subtype

Conclusions

  • UK GPRD cohort women who had been prescribed HT
  • HT associated risks did not vary significantly cross the four main tumour subtypes examined
  • Findings from the GPRD agree with those reported previously from other studies with prospectively collected information on HT use.

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Nicola Dennis
Knowledge and Intelligence Team (W Midlands)
Incidence, survival and treatment patterns for patients with head and neck sarcoma

Presentation

1% of all malignancies in England are Soft tissue sarcoma
Narrowed down to head and neck the numbers are even smaller

With the very small numbers of incidence there are limited studies looking at incidence and survival rates.

Both Improving Outcome Guidance in 2004 and 2006 specifically had improvements for head and neck.
Because of the small numbers its hard to see if anything has changed.

4796 head and neck sarcomas in 1990-2010

MDT specialty – positive outcomes since the guidance was set out where we can see that there has been a significant increase in referral to the right MDT specialty.

Patient spread for surgical treatment. Data shows that there are number of trusts that might only have treated 1 patient in the entire 10 years of the study!

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Kwok Wong
University of Birmingham
Risk of Adverse Health and Social Outcomes up to 50 Years After Wilms’ Tumour: The British Childhood Cancer Survivor Study

I will post a link to the presentation once available.

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Plenary 4 – Delivering outcomes that matter – Panel debate with Q&A to the panel
Chair: Robert Peston, BBC’s Economics Editor

• Mr Sean Duffy, National Clinical Director for Cancer Services, NHS England
• Mr Ciaran Devane, Chief Executive, Macmillan Cancer Support
• Professor Peter Johnson, Chief Clinician, Cancer Research UK
• Dr Jem Rashbass, Director for Disease Registration, Public Health England
• Mr Andrew Wilson, Chief Executive, Rarer Cancer Forum
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Ciaran Devane – Chief Exec – Macmillan
We need to move to a strategy when we think in a different way rather than the economics.

We are talking a great deal about the value of services and NHS etc rather than the value of and to the individual.

Changes in the NHS – are we spreading our resources too thinly?

Sean Duffy – National Clinical Director for Cancer NHS England
No doubt the point of contact for you within the health service should be the most important thing. We’ve not yet got it right. If we’re going to visit better outcomes then we need to tackle the first point of contact too.

We don’t wrap the system around the patients enough.

In terms of the data itself – it’s easy to look at national data and say were good at this or that. We can look at a local level. We need to create ownership of the data around the geographies to be sure their own data is better and is owned. Working collectively to gather for the greater good.

Rich national dataset that we can and must use but we haven’t yet made great inroads in it. Need to make more out of the data.

Finally, with such a rich set of data and the ability to intelligently obtain information from it. We need to get cleverer at using the data in order to year on year look at the services to ensure we can achieve the best.

Prof Peter Johnson, Chief Clinician, Cancer Research UK
Echo the good things said about NCIN and the work they do. No doubt research using the data has been saving lives for many years. We know more about how to reduce the risk of cancer and determine the best treatment and long term outcomes.
How are we going to improve further and get up and beyond the levels of other countries?

We know there are at least 10 different types of breast cancer. We know asbestos causes mesothelioma.

Key obstacles we need to address: Regulation – looking at EU regulations and ability to track patients through system and outcomes will be compromised if EU data systems come in.  We must at all costs make sure work is not held down by regulations.
Changes in the health systems recently has given us problems. Relationship with the information centre CPRD and difficulties of joining different data has given us delays and loss of capabilities in the Registry. This has stopped us doing as much as we would have liked and can achieve.

Public perception of data and it’s management has been undoubtedly damaged by care.data. This was a fundamental problem and unsettling. We have to overcome this. There have been ZERO breaches in any confidentiality of the Cancer Registry.

25% to 50% alive 10 years from diagnosis of cancer. CRUK want to bring this to 75% in the next 10 years. We need data to understand this and move forward. Stratified medicine has to understand at a detailed molecular level. We will only be able to capitalise on that if we can get the data systems right and keep them functioning.

Data is a precious life saving resource. Do not take it for granted. Fight to maintain the system that we have.

Dr Jem Rashbass, Director for Disease Regulation PHE
Worth reflecting on how we got here and what this is about  We have had earthquakes of public trust. This is YOUR clinical information that we collect and we are duty bound to look after it and my responsibility to make sure that I protect patient confidentiality.
As Peter has said the support we’ve had over the years to look after your data and you can request it’s removal from the Cancer Registry.

This is about delivering care to individuals. You’ll treat them on the basis of the stats but as we move to personal care it’ll be the molecular abnormalities that determine your outcome.

We need to maintain the public support for data collection and NCIN database that puts the potential for cancer care in this country further forward than anywhere else in the world. In the next 5 years we will have extraordinary ability to provide the most personalised cancer treatment.

Andrew Wilson, CE Rarer Cancer Forum
Current state of play for data. Clear that public feeling has been shaken. Rarer cancers are rare. Data on rarer cancers will be much more identifiable. Huge amount of exciting work going on using data for rarer cancer.

Use of data in rare cancers. Hidden cancers and less visible to the public.
Huge demand for this sort of data. Need to meet this and produce reports that are useful.

NCIN route for diagnosis project showed ongoing problems for cancer patients go far beyond those related to cancer.

We need to be much more open with the data that we hold. Ensure patient identifiable information is removed from data sets. Once this has been done the data that we have is published. Closed shop needs to go. Automate data flow around the system to ensure sticking to rules and make better use of data that we do at present.
We need to work collaboratively to come up with solutions where problems exist.

Q&A
Q – How can we ensure the diagnostic experience for young people is improved?
SD – we have a first point of contact system designed 60 years ago. We need to tackle it externally and internally. Simple things needed – proactive approach to primary care. Safety netting – young person with a set of symptoms its probably the last place they want to be… be proactive and should raise a flag for tests. We have created a mechanism whereby the referral is the only route – needs to be challenged. GP should be able to make a clinical decision on the basis of facts not ask the patient to wait!
JR – We need to recognise that a missed diagnosis is one that everyone inc GP regrets. However some cancers in a young person are difficult to detect. They are rare. Symptoms and signs of a brain tumour are subtle. No of patients that a GP sees with those every week, it’s difficult to identify. Where the value of the dataset comes not from surveillance but that we should learn from every case. How do we raise our game?
SD – there are risk assessment tools that allow patients to flag up symptoms.
You can start to identify in an active way any of the GP patients that maybe at higher risk using some of these tools and data set.

RP – GPs feel they don’t have the level of control and responsibility due to other constraints about referring and cost.
CD – The guidance at the moment is written to say send us these patients but often the ones that don’t fit that mould are overlooked because they don’t fit that picture.
Be Clear on Cancer – enables the patient population community to know what to ask for and what symptoms.
PJ – I think there is a massive amount of data that tells us a lot about patterns of referral. And the outcomes from this. Feeding the information back into the system is incredible important.

Q – As a researcher the amount of time it takes to get access to data approved throughout he current regulatory approval system. Is there a strategy to help researchers get access to the data and make use of them in a more timely way.
JR – Richard’s experience shared by others. We’ve tied ourselves in knots frightened about releasing data and protecting the confidentiality. We need to recognise what you want us to do. Inside PHE we are trying to deal with it and create the structures to manage the data release. The demand for the data is large. We have disadvantaged ourselves by separating the people who pull the data and those who analyse it.
I think we do need a clear process of maintaining that public confidence.
Complex area but we need to be better at giving data confidentially.

RP – What is your attitude to selling data?
JR – Govt data is not available. Not a resource from which to make money. The data that we collect on you is for the social good BUT need to protect patient identifiable.
Financial constraints on delivering personalised health care will not be cheap. We need to enter into the discussion with industry to pay a fair price and benefit.

Q – How big a threat to our ability to gather and use data would changes be that require consent to use the data each time? This would negate the value of a Cancer Registry.
A – It’s a risk and will undermine everything that we’re trying to do. We need our MPs to change this view and to ensure that this change does not take place.

Q – One of the ways that we can prove that consenting to use of data is to show the public how the data can be used for good and can be done.
CD – Hugely disappointed when cancer networks became unpopular. People didn’t believe in coordination. We need to make use of the strategic clinical networks. Make sure the patient voice is embedded in the senates, and clinical settings. We need to be more assertive and move together.
JR – Some basic processes. Transparency and openness. Audit – any patient can approach and ask who looked at my data. Every patient who wishes can have access via a patient portal like the brain hub. An absolute right of opt-out. No process that makes it difficult to do that. I think that is what is needed to protect the data set that we’ve got and we need the community to act and educate the wider audience.

Q – Despite significant Govt rhetoric influencing the NHS work we need to collect ht patient voice at and put it back into the system. How can we go about changing this?
SD – I believe in the patient voice entirely. Within NHS England the patient survey is the most successful at influencing. We need to make more use of it.

Q – NCIN was founded in 2008 with mission to provide the UK with the best intelligence in the world. What does the panel think the new mission for the NCIN should be to take us forward in th next 5 years.
JR – We need to move somewhere else. I want a low level objective to make the patient and the clinician at the centre of the data store. So you can ask where am I in the system? You can check you’re getting the best and ensure that no cancer is left out. Patients and the public at the centre for cancer.

RP – When you collect data that is at a granular level are you recording it?
JR – Yes we are. We need to know what receptor it has. If it responded to medication. etc etc. Absolutely linking it into all sorts of datasets to look at a much bigger picture and make it more personalised.
PJ – 4 years of outstanding progress and 1 year of challenge. I think it’s time to reaffirm the quality of the data and now we need to see it and put it in front of the people who generated it, people, public, patients, clinicians etc. Want to see equally superb access to it.
CD – based on outcomes not last year’s data.

Q. – When a patient comes into hospital with advanced cancer, the patient has rarely been recording if they’ve been attending primary care prior to emergency presentation?
Should we incentivise GPs by giving them QoFs? Perhaps to embed good practice for a period of time.
PD – Both London integrated cancer centres have been involved in looking at attendance of A&E and that will give us some answers about the gaps. I do think there is something about incentivising a better pathway of care. We need to use everything in our power to make the system work.