• OPERATIONAL POLICY 2008


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    • Abstract: The Trust's commitment to the ongoing growth and development of neuro-oncology ... Surgery rates for Neuro-oncology vary, although the national figure is suggested as. being in the region of 10 ...

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Operational Policy for the Care of patients
with suspected Neurological malignancy
South East London Cancer Network
and Kent and Medway Cancer Network
OPERATIONAL POLICY 2008
Agreed By:
Mr. K. Ashkan (Lead Clinician Neuro-oncology, KCH) on behalf of the neuro-
oncology MDT and the Cancer Networks
Date: 9th December 2008
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(Joint) Cancer Centre
Operational Policy for the Care of patients with suspected neurological
malignancy
Table of Contents
1.0 Introduction ...................................................................................................... 4
2.0 Neuro-oncology Catchments Population and Activity ...................................... 6
3.0 MDT Structure ................................................................................................. 8
3.1 Core Team Members ................................................................................... 8
3.2 Extended Team Members .......................................................................... 10
4.0 The MDT Meeting .......................................................................................... 11
4.1 Weekly Specialist Neuro-oncology MDT meeting ..................................... 11
4.2 Role of the MDT meeting ........................................................................... 11
4.3 Access to the MDT meeting ....................................................................... 11
4.3.1 Intra-hospital Referrals :...................................................................... 12
4.3.2 Patient Booking ................................................................................... 12
4.4 Structure of the MDT Meeting .................................................................... 13
4.5 Responsibilities of Neuro-oncology Lead Clinician..................................... 13
4.6 Attendance at MDT meetings: .................................................................... 13
4.7 Relationship of the Specialist MDT to the Diagnostic MDTs ...................... 14
4.7.1 Kings College Hospital ........................................................................ 14
4.7.2 Other Network Relationships............................................................... 14
4.8 Attendance at South East London Cancer Network Meetings.................... 14
4.9 Operational Policy Annual Review Meeting................................................ 14
4.10 The Role of the Clinical Nurse Specialist ................................................... 15
4.11 Role MDT Co-ordinator .............................................................................. 15
4.12 Service Improvement ................................................................................. 15
The Lead Clinician is nominated as the person responsible for ensuring that
service improvement is integrated into the functioning of the MDT....................... 15
4.12.1 Key worker .......................................................................................... 15
5.0 Organisation of Care...................................................................................... 16
5.1 Surgical Services........................................................................................ 16
5.2 Radiological Services ................................................................................. 16
5.3 Pathology services ..................................................................................... 16
5.4 In-Patient ward facilities ............................................................................. 17
5.5 Oncology Services ..................................................................................... 17
5.6 Palliative and Supportive Care ................................................................... 18
5.7 Other Clinical Support Services ................................................................. 18
5.7.1 Neuropsychology ................................................................................ 18
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5.7.2 Physiotherapy ..................................................................................... 19
5.7.3 Speech and Language Therapy .......................................................... 19
5.7.4 Occupational Therapy ......................................................................... 19
5.7.5 Counselling ......................................................................................... 19
5.8 Citizen Advice Bureau (cab)....................................................................... 20
6.0 Clinical Guidelines: ........................................................................................ 21
6.1.1 GP consultation................................................................................... 21
6.1.2 Appropriateness and timeliness of urgent and suspected neurological
tumours GP referrals ......................................................................................... 22
6.2 Referral Guidelines – South East London Cancer Network and Kent and
Medway Cancer Network referring diagnostic teams 22
22
6.2 Investigations prior to referral..................................................................... 22
6.3 Surgical Guidelines .................................................................................... 23
6.3.1 Surgical Procedures:........................................................................... 24
6.4 Pathology guidelines .................................................................................. 24
7.0 Data Collection .............................................................................................. 25
7.1 Neuro-oncology Database and Minimum dataset ...................................... 25
8.0 COMMUNICATION AND PATIENT SUPPORT ............................................. 26
8.1 Communication with Patients and Families................................................ 26
8.2 Communication with General Practitioners and referring Consultants ....... 26
8.2.1 Notification of General Practitioner:..................................................... 26
8.3 Patient Access – Travel and Accommodation ............................................ 27
9.0 Audit............................................................................................................... 28
9.1 Cancer Waiting Times ................................................................................ 28
9.2 Patient Satisfaction Survey ........................................................................ 28
9.3 Clinical Outcomes Audit and Action Planning ............................................ 28
10.0 Participation in approved clinical trials ........................................................... 29
11.0 Appendices .................................................................................................... 30
11.1 Patient Access - Travel and Accommodation............................................. 38
Appendix 1 MDT proforma
Appendix 2 Service Improvement Action plan
Appendix 3 Patient pathway
Appendix 4 Referral proforma and guidelines
Appendix 5 SELCN Keyworker handover proforma
Appendix 6 Summary number of neurosurgery procedures performed on
Kent and Medway resident patients with Neoplasms
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1.0 Introduction
Specialist neuro-oncology surgery has been a key service provided by the
department of neurosurgery at Kings College Hospital (KCH) ever since its
establishment in 1995 following the merger of the neurosciences units at the Brook
and Maudsley Hospitals. Prior to the merger, high quality neuro-oncology service
was a well-recognised feature of both the latter hospitals. Kings College Hospital is
part of the Joint Cancer Centre in partnership with Guy’s and St Thomas’s Hospital
(GSTT).
The implementation of Improving Outcomes Guidance for People with brain tumours
and other CNS tumours is progressing in line with the local network agreed action
plan (standards to be issued).
Consultant neurosurgeons work in partnership with a comprehensive multi-
disciplinary team (as defined by Improving Outcomes Guidance). The infrastructure
within which the neuro-oncology service is provided includes 63 neurosurgical adult
and 10 paediatric ward beds, a 12-beded neurosurgical high dependency unit and
three operating theatres equipped with neuro-navigational, image guidance and
stereotactic equipments necessary for optimal neuro-oncological surgery. Extensive
neuroradiology services and expertise are available on site including two 1.5 Tesla
MRI scanners and dedicated CT scanner for neurosurgery. The oncology services
are located at the closely linked Guys and St. Thomas’s and Maidstone Hospitals.
The Trust’s commitment to the ongoing growth and development of neuro-oncology
services has been demonstrated by the recent employment of further neurosurgeons
with subspecialty interest in neuro-oncology; set up of the teleconferencing facilities
allowing three way live discussion of the MDT’s patients between Kings, St.
Thomas’s and Maidstone Hospitals; investment in stereotactic and surgical
equipments; and the potential plans for purchase of an intra-operative scanner.
Our vision is to work with local clinical teams to support local diagnosis and care,
through providing ready access to the very highest level of clinical expertise and
quality. We believe that patient care should be delivered locally wherever possible
and we are working with our partners in South East London Cancer Network, Kent
and Medway Cancer Network to further establish the communication, technology and
outreach services that will enable us to minimise journeys to the centre and maximise
use of local resources.
King’s is committed to improving patients’ experiences of care and providing the
highest quality, personalised support to patients and their families (3.8 million
catchment area). Experienced Clinical Nurse Specialists are central to the MDT and
the holistic care of our patients. There is a separate MDT for Paediatrics and young
adults, supported by an Oncologist from the Royal Marsden Hospital with dedicated
sessions. Kings maintains close links with the Royal Marsden Hospital. We have an
ongoing service development strategy that includes gathering feedback from patients
on all aspects of their journeys through our care. For outpatient attendances and
inpatient admission, King’s is compliant with all cancer waiting time targets.
Children and Young Persons will be managed according to the South London and
Kent and Medway Children and Young Persons pathway.
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The Children and Young Persons neurosurgery and in-patient care is compliant with
the South London and Kent and Medway age appropriate pathway.
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2.0 Neuro-oncology Catchments Population and Activity
King’s College Hospital serves a large geographical area for its neuro-oncology
services, including the natural catchment area of south London and Kent. A
significant volume of work is also received from the rest of London and across the
country.
For Neuro-oncology in particular, the service currently receives referrals from:
South East London Cancer Network:
Guy’s and St Thomas’ NHS Foundation Trust – local MDM
Bromley Hospitals NHS Trust, Princess Royal University Hospital – local
neurology MDM
Queen Elizabeth Hospital, Woolwich
Queen Mary’s Hospital, Sidcup – local MDM
University Hospital Lewisham
Royal Marsden Hospital (paediatrics and young adults)
Kent and Medway Cancer Network:
Medway Foundation NHS Trust, Medway Maritime Hospital
Dartford and Gravesham NHS Trust, Darent Valley Hospital
East Kent University Hospitals NHS Trust:
Queen Elizabeth the Queen Mother Hospital
William Harvey Hospital – local MDM
Kent and Canterbury Hospital
Maidstone & Tunbridge Wells NHS Trust
Kent and Sussex Hospital
Maidstone Hospital – local MDM
Surgery rates for Neuro-oncology vary, although the national figure is suggested as
being in the region of 10-15%. The King’s neuro- oncology team expects to carry out
over 380 surgical procedures this year and these numbers are growing
Fig 1: Neuro-oncology surgical procedures undertaken by the King’s team in the last
5 years.
Year Numbers
2001/02 186
2002/03 237
2003/04 264
2004/05 294
2005/06 348
2006/07 377
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Catchments Population King’s is the referral centre for neuro-oncology for the
South East London Cancer Network (SELCN) (population of 1.5 million 2003) and
the Kent and Medway Cancer Network (KMCN: population 1.8 million (1.6million
excluding East Sussex) 2006). We also take a proportion of patients from South
West London.
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3.0 MDT Structure
Core team members or their cover attend the meeting on a weekly basis. Weekly
MDT attendance is recorded. (2F-211) The MDM has identified representation at the
Tumour Working Group (TWG). (2F-207). In addition, the specialist MDT welcomes
attendance from the unit hospitals although it is recognized that it is not possible for
them to attend every week. However, video –conferencing is available to enable this
to happen
3.1 Core Team Members
Surgical Team Lead and Cover arrangements
Mr K Ashkan Lead Clinician for neuro-oncology and consultant
neurosurgeon with subspecialty interest in neuro-
Email- oncology
[email protected]
020 3299 3285
COVER – Mr. Ashkan’s specialist registrar
Mr. R Gullan Consultant neurosurgeon with subspecialty interest in
Email- neuro-oncology
[email protected]
020 3299 4863
COVER – Mr. Gullan’s specialist registrar
Mr C Chandler Consultant neurosurgeon with subspecialty interest in
Email- paediatric neuro-oncology
[email protected]
020 3299 3020
COVER – Mr. Chandler’s specialist registrar
Mr R Bhangoo Consultant Neurosurgeon with subspecialty interest in
E-mail- Neuro-Oncology
[email protected]
COVER – Mr. Bhangoo’s specialist registrar
NOTE: Neuro-surgical SpR on Call contact Mobile 07747 562 094
Neurologist Team Lead and Cover arrangements
Under discussion
COVER
Radiologists – Lead and Cover arrangements
Dr T Hampton Consultant neuro-radiologist, Lead, KCH
Email-
[email protected]
k
020 3299 4890
COVER – Dr N Sibtain (Consultant neuro-radiologist)
Email- [email protected]
020 3299 4890
Oncologist Lead and Cover arrangements
Dr R Beaney Consultant neuro-oncologist, GST
Email-
[email protected]
COVER – SpR Neuro-oncology
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Dr G Sadler Consultant neuro-oncologist, Kent and Maidstone
[email protected]
COVER – Dr SpR Neuro-oncology
Dr L Brazil Consultant neuro-oncologist, GST
Email-
[email protected]
COVER – SpR Neuro-oncology
Neuro-pathologists Lead and Cover arrangements
Dr S Al-Sarraj Consultant neuro-pathologist and Lead, KCH
Email-safa.al-
[email protected]
020 3299 1958
Dr I Bodi Consultant neuro-pathologist
Email [email protected]
020 3299 1954
Dr A King Consultant Neuro-Pathologist
Email- [email protected]
020 3299 1953
Neuro-Psychologist Lead and cover arrangements
Dr A Costello
Email- [email protected]
020 3299 5408
Clinical Nursing Team
Ms R MacArthur Clinical Nurse Specialist Neuro-oncology KCH
Email- Lead for Service User & Carer Issues
[email protected]
k
020 3299 4151
Ms V Hurwitz Clinical Nurse Specialist Neuro-oncology KCH/GSTT
Email-
[email protected]
020 3299 4151
Palliative Care
Dr R Burman Consultant, Palliative Care, KCH
Email-
[email protected]
020 7848 5520
COVER – SPR Palliative care
Therapies Rotational to MDT attendance
Occupational Therapy 020 3299 2338
Physiotherapy 020 3299 2724
Speech and Language 020 3299 4665/1809
Therapy
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MDT Coordinator
Ms Maureen Shand Neuro-Oncology Co-ordinator – Kings College Hospital
neuro-
[email protected]
020 3299 4151
COVER – Member of Cancer Data Team
MDT secretary Provided by Kings Clinical Nurse Specialists
3.2 Extended Team Members
Surgical Team
Mr P Bullock Consultant neurosurgeon with subspecialty interest in
Email- pituitary tumours
[email protected]
020 3299 3284
Mr N Thomas Consultant neurosurgeon with subspecialty interest in
Email- base of skull and pituitary tumours
[email protected]
020 3299 3289
Mr R Selway Consultant neurosurgeon with subspecialty interest in
Email- epilepsy surgery
[email protected]
020 3299 3285
Mr D Walsh Consultant neurosurgeon
Email-
[email protected]
020 3299 4196
Mr S Bassi Consultant neurosurgeon
[email protected]
020 3299 5155
Mr C Tolias Consultant neurosurgeon
Email-
[email protected]
020 3299 3282
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4.0 The MDT Meeting
4.1 Weekly Specialist Neuro-oncology MDT meeting
The neuro-oncology MDT meets weekly to ensure all patients are discussed
contemporaneously and is held on Friday afternoons at 1 pm in Belgrave MDM
Room, Ground Floor, Hambledon Wing at King’s College Hospital. The room is
equipped with teleconferencing facilities to allow live discussion of patients between
Kings, Guys and St Thomas’s and Maidstone Hospitals. All core members or their
cover, attend each meeting.
4.2 Role of the MDT meeting
To identify and review all patients with neurological tumours within the supra-
regional network, ensuring rapid and equal access
To confirm diagnosis and stage of the disease
To decide on the appropriateness of further investigations and staging
Assess suitability and surgical approach to the tumours
Plan treatment
Referral for palliative care in advanced disease
To ensure proper documentation of all patient in notes and database
To ensure decision made are communicated to General Practitioners and
referring consultants
Discuss post operative patients to correlate radiology and histology and to
decide on further management including radiotherapy, chemotherapy or
further surgery
To discuss management of patients with recurrent disease
To ensure feedback to referrers regarding the appropriateness of referral in
line with agreed guidelines
To assess therapy needs of patients
4.3 Access to the MDT meeting
All patients with suspected neurological tumours should be referred to and discussed
at the specialist neuro-oncology MDT meeting. The referral should be made using
the standard proforma (Appendix 1) which is emailed/ faxed to the Clinical Nurse
Specialist/MDT co-ordinator. Emails and contact details of the Clinical Nurse
Specialist/MDT co-ordinator are made available to the all referring teams (SE London
and Kent and Medway Cancer Network). All referral details are documented and
later filed in the case notes. It is acknowledged that there may not be a King’s case
notes at this stage of referral. These patients are discussed in the next MDT meeting
to formulate a management plan. For some patients it may not be appropriate to
travel to the specialist centre as there may be clear contraindications to surgery due
to co-morbidity or widespread metastatic disease (Refer to referral guidelines). The
details of such patients and the proposed MDT treatment plan (palliative care,
chemotherapy) will still be collected and entered in the data base for audit purposes.
The referrers are welcome to attend meetings. Video-conferencing is used.
All patients to be discussed must be referred to the MDT co-ordinator by 12
noon Wednesday for the complete list to be circulated to the Core MDT by
midday Thursday for the Friday meeting. Scans must be sent via imagelink and if
this is not available then a CD (Dicom) of scans need to be sent to the MDT co-
ordinator. It is the responsibility of the referring consultant to ensure that the relevant
radiology is available.
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The agreed management plan for each patient is documented using the standard
proforma (Appendix) during the meeting on the Neuro-oncology database and
minuted by the MDT secretary.
Recorded outcomes are circulated to each member of the team, with a copy of
each individual patient’s outcome placed in their notes. Referring consultant and
GP will be notified within 24 hours.
4.3.1 Intra-hospital Referrals:
All patients admitted to King’s College Hospital with a suspected or confirmed
diagnosis of neurological tumours should have already been discussed in the
previous MDT meeting. It is however recognised that there will be times when a
patient may be admitted and /or operated without previous discussion in the MDT
meeting, primarily because of the clinical urgency of the case. In all such situations,
the patients should still be discussed in the following MDT meeting in order to
formulate further management plan. A member of the admitting neurosurgical team
should be present at the MDT meeting to present the clinical details and feed back
the recommendations.
4.3.2 Patient Booking
Once the neuro-oncology MDT has decided that neurosurgical input is required for
management of a patient, depending on urgency of the case, patient may either
require admission/ transfer to the Kings College Hospital site or may be booked into
the neuro-oncology clinic.
For those patients requiring admission, the neuro-oncology CNS will liaise with the
surgical team and the bed manager regarding a suitable date. Patients with less
urgent needs are seen in the next neuro-oncology clinic which is held on the Kings
College Hospital site and runs on the 2nd and 4th Monday afternoon of each month.
All information/ arrangements are fed back to the referring team by the neuro-
oncology CNS.
Where a patient is reviewed a second or subsequent time by the MDT a new form
will be generated and treated as above.
See Appendix for contact details
Radiology must be sent on image-link or a CD, rather than via email. These can then
be viewed and discussed at the MDT meeting for specialist opinion. Local hospital
PACS systems cannot be shown in the MDT meeting room.
For urgent transfer/admission requests:
Complete Neuro-Oncology Referral Proforma and contact Neurosurgical Registrar at
Kings College hospital on mobile 07747 562 094 or page KH0777 (via switchboard)
to arrange physical transfer/admission.
Generally there is no waiting time and patients are discussed at the next meeting
following receipt of their referral. As part of the Neuro-oncology Cancer Centre
developments we have an established referral proforma and guidelines which sets
out required referral information. We ask always to be advised of existing diagnostic
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tests and staging so patients are not subject to repeat tests unless clinically
indicated.
All patients with a suspected or confirmed neurological malignancy (Brain or CNS
tumours) should be notified to the specialist team. The team will agree the treatment
options for each patient. The team may also discuss patients diagnosed outside of
the Cancer Centre where the agreed management plan may be for the unit to
continue the care. All patients will have a referral form filled in by the referring local
team and a record of the MDT discussion will be kept. These forms will be subject to
audit on an annual basis.
In urgent circumstances, clinical decisions may need to be made outside of the MDT
meetings. In such cases, the consultant in charge of the patient will initiate or refer
for treatment without delay and the management plan will be presented at the next
MDT.
4.4 Structure of the MDT Meeting
The Lead Clinician is the chairperson of the MDT meeting who has responsibility for
making sure that the meeting runs efficiently and that the appropriate conclusions of
each case are summarised so that they can be recorded by the MDT co-ordinator.
All cases are presented and must include name, age, presenting symptoms, co
morbidities, base line level of daily activities and quality of life, current medications,
findings on examination (general and neurological) and all pre-operative/ staging
investigations. Radiology and pathology is presented by appropriate members of the
team
4.5 Responsibilities of Neuro-oncology Lead Clinician
The principal responsibilities of this role is to ensure high quality services and clinical
management for all patients suspect of having a neurological malignancy, in line with
the objectives as laid out in the Manual of Cancer Service Standards and as
documented in the Trust MDT role description and confirmed in the letter from the
Trust Lead Cancer Clinician to the neuro-oncology MDT lead
That is:
To ensure that designated specialists work effectively together in teams such
that decisions regarding all aspects of diagnosis, treatment and care of
individual patients and decisions regarding the team’s operational policies are
multidisciplinary decisions.
To ensure that care is given according to recognised guidelines (including
guidelines for onward referrals) with appropriate information being collected to
inform clinical decision-making and to support clinical governance/audit.
To ensure that mechanisms are in place to support entry of eligible patients
into clinical trials, subject to patients giving fully informed consent.
To ensure that the MDT Co-ordinator will ensure that minimum data is
collected as per the national cancer dataset.
4.6 Attendance at MDT meetings:
Core members must attend 75% of all MDT meetings each year. Attendance at the
meetings is recorded by the MDT co-ordinator and is reviewed by the lead clinician
on an annual basis.
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4.7 Relationship of the Specialist MDT to the Diagnostic MDTs
4.7.1 Kings College Hospital
Neurosurgery for patients with neurological tumours and the immediate post-
operative care is performed at King’s College Hospital site. These patients are all
discussed at the specialist KCH MDT meeting. However, the MDT also performs the
important function of dealing with neuro-oncology cases that are inoperable for
reasons such as multiple metastases, severe co morbidity, and those referred for
palliation.
Local Network MDT meetings are being developed.
4.7.2 Other Network Relationships
The MDT will work with its partners (Guys and St Thomas’ and Maidstone Hospitals)
as well as the local hospitals in the catchment area.
Patients requiring chemotherapy and radiotherapy will be given treatment as close to
home as possible at the nearest local unit. The treatment will be given under the
guidance of local chemotherapy and radiotherapy protocols.
4.7.3 Annual Review
The neuro-oncology specialist team will meet at least annually with all referring
teams to discuss the operational policy (including referral and treatment guidelines),
radiotherapy, chemotherapy and to perform a collaborative audit of all patients
referred.
The specialist team is continuously working to improve communication with all
referring hospitals.
4.8 Attendance at South East London Cancer Network Meetings
There will be representation from the key stakeholders and the network management
teams from the South East London Cancer Network and Kent and Medway Cancer
Network.
There is a Senior Lead, Medic and Nurse Manager who attend the Network forum.
The Chief Executive attends the Network Board Meetings.
4.9 Operational Policy Annual Review Meeting
The MDT will meet at least once each year with all key stakeholders to review the
operational policy. Changes will be disseminated to all key stakeholders by the
Neuro-oncology clinical lead. This meeting is chaired by the Clinical Lead for Neuro-
oncology. Any changes made to the operational policy will be discussed in this
meeting. The lead clinician takes the responsibility of circulating the updated
operational policy and the topics which will be discussed. Other core members who
wish to bring about changes should notify the lead clinician of the topics they wish to
discuss prior to the meeting. This meeting is minuted.
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4.10 The Role of the Clinical Nurse Specialist
The Neuro-oncology Clinical Nurse specialist role includes:
To be the first point of contact for patients accepted under the care of the
MDT.
Act as key-worker or responsible for nominating the key worker for the patient.
To educate support and counsel patients providing relevant written information
as appropriate.
To lead on patient and carer’s communication issues for the MDT.
To co-ordinate the pathway of the patients referred to the neuro-oncology
MDT meeting, ensuring where clinically appropriate that delays are avoided.
To contribute to the MDT discussion, patient assessment and care planning
decisions of the team.
To ensure that patients are able to access members of the MDT for support
and advice as appropriate.
Develop the nurse led services as agreed by the MDT.
Contribute to the Trust wide development of cancer services as requested and
work as a member of the Cancer Nurses Forum.
Provide teaching and educational input to relevant courses and provide expert
nursing advice and support to other health professionals in the area of
neurological cancer.
Ensure effective written communication and verbal communication between
the MDT, referring Trusts, GPs and specialist centers.
Work with the Trust Cancer Data Team supporting the collection of neuro
cancer data and involve in clinical audit.
To contribute to the management of the neuro oncology service.
To be involved in research in the area of neurological cancer.
4.11 The Role of the MDT Co-ordinator
The MDT Co-ordinator supports each MDT meeting. This co-ordinator ensures that
all patients requiring discussion are added to the meeting agenda, that all necessary
diagnostic information (scans, reports etc) is available, that the management plan
agreed at the meeting is recorded and that cancer waiting time data is collected. The
MDT co-ordinator works closely with the CNS, supporting the exchange of
information between the specialist team and referring units. Referring units are able
to access the MDT co-ordinator direct through email/fax/phone to ensure that
patients are discussed at the specialist MDT without delay. Requests and
organisation of diagnostic information are co-ordinated through this role.
4.12 Service Improvement
The Lead Clinician is nominated as the person responsible for ensuring that service
improvement is integrated into the functioning of the MDT.
4.12.1 Key worker
All patients accepted to the MDT will be allocated a Key Worker who will co-ordinate
the care through the pathway. This will be the most appropriate person.
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5.0 Organisation of Care
5.1 Surgical Services
All surgery for neurological tumours within the catchment networks is carried out on
the Kings College Hospital site by members of the core team.
Following discussion at the MDT meeting and completion of recommended
investigations at the local hospital, patients accepted for surgical intervention are
admitted to the KCH site, usually a day before the planned surgery. Depending on
clinical and technical issues, patients may undergo biopsy, debulking or complete
resection of tumours. The theatres at KCH are equipped with state of the art
stereotactic and image guidance systems to allow localisation and accurate approach
to the tumours. Expertise is available for functional mapping and awake surgery if
needed. Following surgery, patients are cared for on the neurosurgical high
dependency and then ward beds. The patients are then discussed in the subsequent
MDT meeting to correlate the histology, radiology and clinical findings and formulate
further management and referral-on aspects.
There are also regular clinics preceded by an MDT meeting for discussion of all
patients to be seen in the clinic.
It should be noted that all consultant neurosurgeons at KCH, along with their team,
take part in the emergency on call rota. Advice and expertise are therefore always
available should a patient require urgent transfer/ intervention.
See Appendix for contact details
5.2 Radiological Services
Cross-sectional diagnostic imaging (CT and MRI) from both King’s College Hospital
and the regional district general hospitals is reviewed at the neuro-oncology MDT by
a consultant neuro-radiologist both pre-operatively and post-operatively. With some
difficult cases we have the option of using MR spectroscopy or functional MRI.
Expertise for CT guided biopsy of spinal and para-spinal tumours is available. When
a conclusive MDT decision is not possible we have the option of following-up patients
in the dedicated neuro-oncology clinic with further interval cross-sectional imaging
reported by the neuro-radiologist.
See Appendix for attached Neuro-Radiology Guidelines
5.3 Pathology services
The biopsies are reported in the Department of Clinical Neuropathology within 24-48
hours depending on need for immunohistochemistry. Intra-operative (frozen and
smear) diagnoses are available on a 24-hour basis. The reports can be reviewed on
the EPR system immediately after authorisation of the report. The Neuropathologists
undertake a rigorous audit system to review all cases. Neuro-pathology participates
in the national and European QAs for both the neuropathologists and laboratory
techniques. Molecular techniques are available.
Neuro-Pathology will be reported in line with the RCP guidelines and protocols.
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5.4 In-Patient ward facilities
The unit accepts both emergency and elective admissions from this area.
Neurosciences provides a challenging but exciting working environment and the unit
is committed to providing high quality nursing care, using Essence of Care as a
benchmark for best practice. A Modern Matron, a Practice Development Nurse and a
team of clinical nurse specialists support the unit, providing day-to-day support for
the ward staff and patients and acting as clinical resources.
The unit comprises:
Murray Falconer ward – a thirty one bedded acute neurosurgical ward, caring
for the complete spectrum of elective and emergency neurosurgical conditions
Kinnier Wilson ward – a twenty bedded acute neurosurgical ward, which also
cares for the complete spectrum of elective and emergency neurosurgical
admissions
David Marsden ward – a twenty three bedded neuromedical ward, which, in
addition to caring for elective and emergency neuromedical patients, has a
five bedded telemetry unit. The ward is also the site for the pilot project to set
up a nurse directed cohort of eight designated spinal beds.
Kinnier Wilson High Dependency Unit – a twelve bedded neurosurgical and
neuromedical unit, that provides care for acutely unwell patients that require a
higher level of nursing care and medical intervention than that which can be
provided in the ward environment. Six level three beds are available on the
Surgical Critical Care Unit.
In-patient areas for Young Persons is currently under development. Children
and Young Persons will be managed according to the South London and Kent
and Medway Children and Young Persons pathway.
The Children and Young Persons neurosurgery and in-patient care is
compliant with the South London and Kent and Medway age appropriate
pathway.
Staff development is actively encouraged within the unit, with Band Five and Band
Six staff rotating between the wards, in order to develop clinical skills in the varied
environment of neurosciences nursing. All new staffs have a five day organisational
induction and are also offered a five day local induction. Education is provided either
in-house by the Practice Development team or courses run by the Education
Department. Staffs are encouraged to actively explore opportunities to undertake
relevant postgraduate studies. Staffs are also able to gain valuable mentoring
experience as pre-registration students undertake placements on the unit throughout
their training.
5.5 Oncology Services
Patients requiring adjuvant therapy are treated under the oncology guidelines.
If a patient is not well enough to withstand a full course of treatment, palliative
radiotherapy may be discussed with them. We offer a varied range of palliative
regimes. The aim is to control symptoms and enhance the patient’s quality of life.
Upon a diagnosis of a high grade brain tumour referral to palliative care is offered
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and recommended. This is done either through the multi-disciplinary meeting if the
patient is an inpatient, or it can be done by the clinical nurse specialist at any time
during the patients care. As patients conditions progress the clinical nurse specialist
can then make referrals to community palliative care as agreed by them and the
patient/carer. Palliative care referrals can also be made by the GP.
5.6 Palliative and Supportive Care
There is a well established Palliative Care Service at King’s. Out of hours nursing
care is provided by a number of local providers.
Early referrals for patients on active treatment, given with palliative intent, are
encouraged in the local area. In such patients, the prognosis will usually be limited
and focus of treatment will have changed from curative to palliative. A demonstrable
need for specialist palliative care services must be established. Appropriate reasons
for referral include: pain control, control of other symptoms, e.g. vomiting.
psychological distress of patient/family or carer, terminal care/dying (prognosis
usually less than two weeks) and complex social needs. The patient and/or their
family/carer must be informed and agree to the referral.
All senior staff delivering significant news will be or have underta


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