Cancer

Cervical cancer prevention week 18-24 January 25/1/2021

Cervical screening in primary care should continue to be prioritised alongside cancer referrals, including both high risk and regular call/recall invitations to screening. People on the Shielded Patient List should continue to be invited to and encouraged to attend screening appointments as normal. For cervical cancer prevention week, we would like to share messages that invitations are being issued, screening appointments are going ahead and that all NHS services have put in extra safety measures. There are helpful communications materials that Jo’s Trust have produced as part of prevention week which can be used on your external channels.    

Cancer Services Leaflet and Colorectal Service Telephone Triage Assessment leaflet 25/1/2021

The attached leaflets (attachments 1a and 1b) have been reviewed and updated and have been approved by the PCN Cancer Leads.

Please can practices use these leaflets when talking to patients.  Any queries should be directed to Janine Quate: janine.quate@nhs.net

Suspected or diagnosed cancers and cervical screening 21/1/2021

While recognising the significant pressures on primary care, GPs should continue to refer patients who fulfil NG12 criteria. Where referrals depart from normal practice, robust safety-netting must be in place.

It is important to be alert to overlapping symptoms between lung cancer and COVID-19. Urgent referrals for suspected lung cancer are much reduced. The Clinical Expert Group has issued guidance on differentiating between symptoms of lung cancer and COVID-19.

Where possible Faecal Immunochemical Testing (FIT) should be completed alongside lower GI referrals to support effective triage. Guidance on how to embed clinical prioritisation by FIT can be found here.

Cervical screening in primary care should continue and people on the Shielded Patient List should be invited to attend screening appointments as normal.

Breast pain only is not found to be a sign of cancer 21/1/2021

Women presenting with breast pain, who on examination have no other signs or symptoms, regardless of their age or the nature of their pain (constant, cyclical, unilateral or bilateral) have been shown to have an extremely low chance of breast cancer.

Ms Julia Dicks, Consultant Breast Surgeon and Chair of the Breast Clinical Delivery Group within the South Yorkshire and Bassetlaw Cancer Alliance: 

“Breast pain referrals currently account for around 20% of all female 2ww referrals into Trusts and with their very low chance of leading to a cancer diagnosis, often only add to the pressure on diagnostics and other health care resources. 

“Breast pain and the worry of breast cancer understandably cause anxiety and patients may of course need some reassurance but in the absence of other signs, there is no need to refer to hospital which, in itself, can further increase anxiety.” 

No patients with solely breast pain should be referred to breast symptomatic clinic without a face to face examination, reassurance, advice as per breast pain pathway - which can downloaded here

Patients should be safety netted in the usual way and if there are ongoing clinical concerns after following the pathway, or any clinical uncertainty when assessing patients, the local Breast team are more than happy to be contacted directly to discuss this by your local routes, eg A&G, Consultant Connect. 

Link: Breast pain only is not found to be a sign of cancer

BEST presentation - Cancer briefing 21/1/2021

Following on from the Cancer Update and more specifically the Clinical Diagnostics Tool, at the BEST event this afternoon, please could we ask that practices refrain from contacting Csigns directly.  We have been notified that a number of practices have contacted the organisation directly and this is likely to cause confusion and potentially jeopardise the procurement process.  As advised in the presentation and discussion the roll out is being managed at Cancer Alliance level and will commence March 2021.  Practices will be informed in due course about accessing and installing the system.  In the meantime if you would like to register interest in being involved in the roll out programme please email Siobhan Lendionowski (Siobhan.lendionowski@nhs.net). 

NHSE Quality of Life Survey 24/9/2020

Public Health England, NHS England and NHS Improvement are leading the way in cancer care by recognising that quality of life (QoL) outcomes are as important to patients as survival. We are launching a nationwide QoL survey in September 2020. Initially we will survey people who have been diagnosed with breast, prostate or colorectal cancer. People with all other cancer types will be included from 2021 onwards.

People will be a sent a survey 18 months after their diagnosis to assess their QoL. The information collected from the survey will be used to work out how best to support the growing number of people living with and beyond cancer. This is an ambitious programme with a scale and depth that isn’t being matched anywhere else in the world.  For more information visit: www.CancerQoL.england.nhs.uk

Please find a more detailed copy and/or bullet point messages in the attached (1).

Collaboration with Transforming Care Partnership Information 3/9/2020

The Cancer Alliance have been in collaboration with Transforming Care Partnership to raise awareness of the importance of visiting the GP practice and  a cancer signs and symptoms awareness communications campaign for those with a learning disability.

Please find attachment 4 and attachment 4a the communications  that have been co-produced with speak up and are being disseminated widely across the learning disabilities networks.

REMINDER: We are changing the way patients Lower GI FIT tests are managed and transported to mirror existing pathology processes 3/9/2020

There will be a change to how patients return their FIT kit. They will no longer be posting samples back but will be taking them back to GP practices. This change will be over a phased period – as it will depend on the existing number of kits in stock in your practice. We ask you to be are aware of the new instructions in the kits when giving one to a patient and instruct patients accordingly i.e. to either post it back or return it to the practice. This is until all the FIT kits with pre-paid envelopes have been depleted. However kits can be put in the local pathology collection from 1 September 2020, even if the instructions say to post and the patient returns to the practice. 

The kit will be booked in at the local pathology lab and sent to the Sheffield Lab for analysis as per before . Results will be sent to the practices through the usual route. A flow chart showing the new route is on attachment 2.  This change in process is partly due to a significant increase in postal costs but more importantly uses existing arrangements for samples/tests and results.​

Vague Symptoms Survey – for GP’s and Practice Staff – extended closing date 31 August 2020  20/8/2020

Thanks everyone who has already completed the Vague symptoms pathway pilot survey. It has already provided us with some great feedback. We would like to receive more individual GP’s feedback still and have therefore extended the completion date. Please can you kindly complete the survey at this link Vague Symptoms Pathway Pilot Evaluation Survey to help us evaluate the pilot. For further details about the pathway please go to this link : VS pathway details  

If you have any queries relating to this work, please contact Siobhan Lendzionowski - Lead Commissioning and Transformation Manager via email at siobhan.lendzionowski@nhs.net Please note that the new deadline for feedback is 31 August 2020.

Thank you for your support with this evaluation.    

Cervical Screening Administration Service  17/8/2020

Following the successful Phase 1 transfer of the Cervical Screening Administration Service (CSAS) back to the NHS in August 2019, Phase 2 involves the allocation of a new telephone number, the staff relocation to NHS run buildings, and the move to working on NHS systems.

From 19 August 2020, the new telephone number for CSAS will be 0300 124 0248; the postal address will remain as PO Box 572, Darlington DL1 9AG.

As part of this second phase, CSAS will also be deleting all old email addresses on 31 August 2020 which link to Capita / PCSE. The quickest and most efficient way of contacting CSAS is by completing this online form 

ICS Cancer Alliance – Opportunity to shape future genomic strategies 10/8/2020

The South Yorkshire and Bassetlaw ICS Cancer Alliance are inviting you to you to join them in a discussion to shape future genomic strategies, and to provide feedback about sample and reporting pathways.

The Genomics Educational Event will take place on Monday, 14 September 2020 and will be virtual on MS Teams 16:00 – 18:00.

Purpose

The aim of this event is to provide information and educational content around the introduction of the new NHS Genomic Medicine Service and the provision of molecular genetic testing for patients with cancer in the South Yorkshire Region. The event will promote discussion to support and inform the direction of the future development of genomic testing. This is a collaborative event to bring together organisations tasked with delivering improved cancer services to patients in south Yorkshire.

Audience

Professionals working in both primary and secondary care across the multi-disciplinary teams, including Clinical Nurse Specialists, oncologists, surgeons, histopathologists, radiologists and MDT co-ordinators.

Outcomes

Attendees will be provided with an understanding of genomic medicine applied in practice:

  • An understanding of the relevance of genomic testing in cancer care
  • Evidence/case studies to illustrate clinical utility
  • An update on the NHS Genomic Medicine Service An opportunity to inform the future provision of genomic testing in cancer—the design of solid tumour panel testing
  • An opportunity to inform the future provision of genomic testing in cancer—mechanisms to feedback relevant results to clinical teams and patients
  • An understanding of the role of genomic medicine from the perspective of key regional partners
  • We hope that you can join us for this exciting educational event

To register your interest and sign-up to the event, please email sybndcancer.alliance@nhs.net

 

i-HEART Cervical Screening re-start 23/7/2020

i-HEART has restarted it's cervical screening pilot within the Extended Hours service. We will operate on fortnightly basis of a Sunday 11:00 - 15:00 from our centre at Chapelfield Medical Centre offering cervical screening examination appointments. We have safety measures in place to protect patients and staff in line with government guidance.  

Our nurses will raise the request for the examination sample on ICE, recording the requesting details as the GP to ensure the results go back to the surgery similar to if the patient had it done at their own practice. This ensures results are with the surgeries in a timely fashion. 

We hope that this initiative will target women who are currently finding it difficult to attend surgeries as workplaces begin to open back up. We also hope that it will give GP surgeries another option to book urgent recalls and routine cervical screening appointments to improve the health of the women of Barnsley during this difficult time for GP practices. 

The referral form should be integrated in to your clinical system already and will pull all the relevant patient demographics and their past cervical screening history. Please send referrals form to barnsleyccg.iheartscreening@nhs.net and we will call the patient and book them in to one of our clinics and handle everything from there for you. 

2 week wait cancer Patient referrals - restrictions confusion by Patients 23/7/2020

- Sent on Behalf of Dr Kadarsha - CCG Clinical Lead for Cancer   

As social distancing and COVID protection measures continues within BHNFT, there are still restrictions within the 2WW referral processes that may affect how patients are reviewed.

Please can I ask that:

  • When referring patients into the 2WW system it is essential that they are made aware that they will be clinically triaged beforehand to ensure safety, and where possible, to reduce patients having to travel to hospital for a face to face appointment. 
  • To let Patients know that they will therefore be contacted by letter or telephone to inform them if their Suspected cancer (2WW) appointment will either be face 2 face, via Telephone or on Video call. 
  • Currently Straight to Test pathways for Upper and Lower GI are not occurring, however patients may still be contacted by a Cancer Triage nurse to discuss their procedure, before having a discussion with the Consultant
  • Where possible, please do not inform a patient of the type of appointment they will receive. Please inform the patient that the hospital will get in touch with them to provide this information.  As BHNFT want to ensure we they can manage the patients expectation of their first OPA as much as possible and prevent distress at this difficult time

We are asking you to do this asap, as we are having issues with patients being ‘confused’ with the type of appointment they are receiving from the hospital. Unfortunately some of the patients are also getting upset and angry with Staff at BHNFT, as they feel that the hospital are adjusting their appointment from what they expected to occur.

Thank you for your support with this.

National Cervical Screening Programme Operational Guidance 8/6/2020

Please find attached the National Cervical Screening Programme Operational Guidance - Invitation and Reminder Letter Intervals. To support providers to respond to the impact of the COVID-19 pandemic, the intervals at which invitation and reminder letters are issued for the NHS Cervical Screening Programme were extended. As part of the restoration of NHS Cervical Screening Programme services post COVID-19, the screening system will begin sending invitation and reminder letters again from 6th June 2020. The aim of this document is to ensure that all cervical screening sample taking providers are aware of the timeframes involved in the restoration of the cervical screening call/recall service and to provide further guidance regarding management of individuals whose screening may have been affected by COVID-19.

Please contact your local Screening and Immunisation Team with any queries.

FIT Testing in Lower GI 2ww referrals 5/6/2020

The Bulletin on 22/5/20 contained information about FIT testing in this group of patients even in the presence of rectal bleeding. The understanding was that this had been decided at the Cancer Steering Group. More recent information indicates that this is not correct and that there is no need to do FIT testing where there is obvious rectal bleeding. Apologies for any confusion caused.

FIT Testing in Lower GI 2ww referrals 22/5/2020

You may recall that an earlier bulletin included a request for FIT testing to be done for all 2ww lower GI referrals to aid with prioritising cases. There has been some feedback that this request conflicts with the advice on one of the previous flow charts that FIT testing was not useful where there was rectal bleeding. The evidence around this is not certain and it was decided at the Cancer Alliance that FIT testing should still be performed even when there was bleeding. Can I therefore reinforce the request from BHNFT that testing is done on ALL such 2ww referrals.  It would also be useful to indicate on the form that the test has been requested. 

Macmillan funding 20/5/2020

Macmillan funding has been secured for the service to continue up to December 2021. Historically, year on year the service comes under review and so to have this news far in advance is great not only for patients but also in supporting the clinical teams.

ALERT: possible cervical screening text messaging scam 18/5/2020

Message from NHS Cervical Screening Programme:  We have received reports today of a possible scam. Some women are being contacted by text message, claiming to be from the call and recall service to advise they are overdue for screening. The message asks them to call a mobile number and provide personal details.

These messages are not from the NHS Cervical Screening Programme.

The Action Fraud Line has been contacted.

All services should ensure that staff dealing with queries from general practices and the public:

  • are aware of the situation
  • handle any suspicious calls and concerns by:
    • reporting them according to local organisational policies
    • alerting the screening and immunisation team (SIT) and the screening quality assurance service (SQAS)

Cervical Screening Restoration Guidance 18/5/2020

Please find attached: NHS Cervical Screening Programme - Restoration Guidance

To support the restoration process and to give time for services to recover, invitation and reminder letters for cervical screening have been delayed for 8 weeks from 9 April 2020 and will begin being posted to women again from around 6 June 2020.

Practices are asked to note/action the following:

  • Start offering women who are eligible and due for cervical screening appointments when sample takers are ready – re: People invited but not screened and people with a delayed invitation
  • Over the next 3 to 4 months, the invitation and reminder letters that have previously been held back ( i.e. during 8 week period) will be added back into the system incrementally- so there may be more individuals than usual requesting a screening test over the catch up period. Individuals with delayed invitations for surveillance are being prioritised for letter production.
  • Individuals who request screening should be offered an appointment.
  • Primary care providers should review their local records or use final non-responder lists to identify individuals whose screening may have been affected by COVID-19 (for example, their appointment has been cancelled and not been rebooked, they have been refused an appointment during the pandemic response, or they have not responded to a reminder letter) and be proactive in contacting them about their screening and giving them opportunity to attend.
  • Page 6 of the guidance is specifically for sample takers and page 15/16 provides a FAQ for patients

COVID FIT 2ww High Risk Lower GI pathway 11/5/2020

COVID-19 has accelerated the interest in the use of FIT in a symptomatic context. We have therefore been working with clinicians in both primary and secondary care -to develop the use of FIT in high risk symptomatic patients who meet the 2WW clinical criteria following national referral guidance.

The pathway attached details the process required in both Primary and secondary care to enable the FIT result to be used as part of the secondary care triage process.  The FIT result will help to inform the risk stratification of 2ww patients - as to the timeliness and most appropriate next pathway step.

A FIT Test is to be initiated in Primary care asap, at the same time as the 2ww referral unless there is rectal bleeding when a FIT test is unhelpful.  You also will need to request completion of FBC, U&E and Ferritin as we know the FIT test and ferritin level aid clinical triaging of patients.  If consultation is face to face also complete DRE if possible.

All patients will have secondary care clinical triage, if specialists decide on alternative treatment the patient will be kept on a tracking list as per normal pathway administrative processes. This will help to ensure safety netting and further follow up at a later date.  This will be reviewed routinely by secondary care clinicians.

Patients WILL NOT be discharged off the pathway on the basis of the FIT test alone- as in some patient cohorts such as those with iron deficiency anaemia may have a false negative FIT result. 

Priority medicines for palliative and end of life care during a pandemic 6/5/2020

In order to manage additional demand for end of life medicines, and ensure safe, equitable and compassionate care for patients, we have worked with the Association of Palliative Medicines, Royal College of GPs, Hospice UK and the Association of Supportive and Palliative Care Pharmacy to publish Priority medicines for palliative and end of life care during a pandemic. This clinical guidance for essential end of life medicines, which sets out the first and second choices for these medicines, will enable the NHS to conserve supplies, switch to alternative drugs when required and minimise waste. This is also being used to guide the purchasing of medicines for the UK. It aims to support healthcare professionals working in palliative and end of life care, including GPs and pharmacists, across hospital, community, social care and hospice settings to work together in managing additional demand for end of life medicines due to COVID-19. This should be read alongside the recently published DHSC standard operating procedure on how to run a safe and effective medicines reuse scheme in a care home or hospice during the coronavirus outbreak.

Letter from Cancer Research UK (CRUK ) 4/5/2020

CRUK have prepared a resource pack to assist practices in optimising your safety netting processes, while managing the corona virus risks. 

Along with this pack they are asking if practices, or the PCN, would benefit from a tailored-on line session on safety netting guidance, to reflect current challenges with remote consultation and patient confidence in presenting to primary care. The sessions can be adapted to be on line with the numbers of staff and time available. Please see attached the letter and safety netting guidance’s and flow chart. For further details contact Rachel Ball; CRUK Facilitator Manager, Tel: 07789174906  or Email Rachel.ball@cancer.org.uk

Updated - Cancer support services response to COVID 19 9/4/2020

Through the LWABC programme the Cancer Alliance continue to work closely with local cancer support organisations to support the huge numbers of people during and beyond their cancer treatment. Current provision: Cancer Support Workers are working to deliver a support service out of the Well building. They will contact all patients on the books at the Well and work with the clinical teams to provide support to all their patients. All face to face support has stopped, however they will contact by phone. We will contact all patients past, present or future who may need us. The contact will be low level wellbeing support and not clinical but patients will be directed where possible.

See attached guidance and daily brief from SYB ICS cancer alliance team.

Macmillan Cancer Support 6/4/2020

We’re doing everything we can to support people living with cancer right now and have updated our dedicated coronavirus information pages with a wide range of support. This includes information on how to deal with social isolation, how to access financial support, end of life care and how coronavirus may impact on a patient’s cancer treatment. There are also now pages specifically for professionals, covering resilience and how to look after your mental wellbeing.

The Macmillan Learn Zone will also be providing additional information and learning resources. If you’re not already signed up, create an account here.  

Call the Macmillan Cancer Support Line for free 7 days a week 9am-5pm 0800 808 00 00.

Stay connected from the safety of your own home - join our Online Community, talk to people who know what you're going through and ask our experts your questions.

Macmillan iHOPE (Help Overcoming Problems Effectively) Online Course for people living with or after a cancer diagnosis 6/4/2020

Macmillan are offering an online peer group support self management course which is particularly relevant at the moment. The course helps to build resilience, rediscover strengths and increase your ability to cope through their programme called iHope (Help Overcoming Problems Effectively). It's a six week programme, involving a minimum of two hours per week, at a time to suit you, if you have access to the internet via smartphone, tablet or PC. Topics include smarter goal setting; priorities and values; living positively with fears for the future; eating well; managing stress and finding things to be thankful for. Start dates for each course are 6 April; 4 May and 1 June

Radiotherapy at Weston Park Hospital 3/4/2020

The radiotherapy department at Weston Park Hospital (WPH) is continuing as “normal”.  They are asking patients to arrive for their appointments as close to their time as possible and to come into the hospital/department alone where at all possible. Some patients may be delayed and some may have their planned treatment schedule shortened according to national guidelines. If any patients are unsure what may apply to them then they can contact WPH. The open evenings held on the second Tuesday of every month are cancelled for the foreseeable future but the Information and Support team are available to answer any questions from patients, relatives or HCPs by telephone or email. It will be available Monday-Friday 8.30-5.00. Contact details for patients: 0114 2265282,sth.rtinfo@nhs.net  (new easier address which we are phasing in) or sht-tr.RTInfo@nhs.net  (old email we are phasing out!).

Support for People with Cancer 3/4/2020

BHNFT Cancer Support Workers are working to deliver a support service out of the Well Centre. Two of the support workers will base themselves within the Well Centre building. They will contact all patients on the books at the Well and work with the clinical teams to provide support to all their patients. All face to face support has stopped at the Well Centre however they will contact individuals by phone. The Well Centre Tel:  01226 733019 http://www.thewellforwellbeing.org.uk/

Palliative and EOLC Symptom management 1/4/2020

Please find attached the COVID-19 palliative and EOLC symptom management and guidance.

Advice on maintaining cancer treatment during the COVID-19 response 31/3/2020

Guidance for the NHS to ensure that cancer diagnosis, treatment and care continues during the response to the COVID-19 emergency. The guidance can be found here:

In summary:

  • Essential and urgent cancer treatments must continue. Cancer specialists should discuss with their patients whether it is riskier for them to undergo or to delay treatment at this time.
  • Where referrals or treatment plans depart from normal practice, safety netting must be in place so that patients can be followed up.
  • Urgent consideration should be given to consolidating cancer surgery in a COVID-free hub, with centralised triage to prioritise patients based on clinical need.

Covid-19 End of Life management 27/3/2020

Please see the attached document for updates on Covid -19 EoL/symptom management in Primary Care and when more information and guidance can be expected.

Guidance for COVID-19 End of Life Care in Primary Care 25/3/2020

It is acknowledged that there is significant concern regarding how high quality end of life care (EOLC) will be delivered to patients in the community, therefore for information on this, please see  CCG Covid-19 End of life guidance for Primary Care.