Spotlight on bowel cancer

Transcription

Spotlight on bowel cancer
Life demands excellence
magazine – spring 2012
Research grants
help lead the way
Celebrating staff
achievements
Meet one of our
hospital chaplains
Spotlight
on bowel
cancer
How The Royal Marsden is
taking a multi-faceted approach
to pioneering treatment
At The Royal Marsden, we deal
with cancer every day, so we
understand how valuable life is.
And when people entrust their
lives to us, they have the right
to demand the very best. That’s
why the pursuit of excellence lies
at the heart of everything we do.
RM MAGAZINE
Executive notes
Contents
12 Bowel cancer focus
How we’re working together
to take on the disease
17 Television times
Behind the scenes of the new
BBC Horizon documentary
set at The Royal Marsden
22 Staff celebrations
Highlights from our 2011
staff awards ceremony
26 Charity plans
Chairman R. Ian Molson on
the year ahead for The Royal
Marsden Cancer Charity
Regulars
04 Hospital news
20 Day in the life
25 PCAG
25 The Friends
26 Fundraising
28 Foundation news
30 Puzzles & prizes
Welcome
to the spring 2012 edition of RM, the magazine for our
staff, patients, carers and Foundation Trust Members.
In this issue, we explore the advances that we are
making in the treatment of bowel cancer and how this
is changing patients’ lives (page 12). We also look at
personalised medicine. We’re delighted to be part of
Cancer Research UK’s Stratified Medicine Programme
(page 5), a project that fits closely with our Centre for
Molecular Pathology. We spend a day with one of our
hospital chaplains, John McLuckie (page 20), and also
look ahead to The Marsden March (page 27). Last year,
we raised more than £800,000 for The Royal Marsden
Cancer Charity, which was a fantastic achievement.
This year, we are aiming to reach our £1 million target.
I hope you enjoy this issue.
Cally Palmer, Chief Executive, The Royal Marsden
RM MAGAZINE 03
HOSPITAL NEWS
INTEGRATING CANCER CARE
SYSTEMS ACROSS LONDON
n 2009, Healthcare for
London published the
Cancer Case for Change
document, which highlighted
the need to improve cancer
services outcomes.
In response to this study, the
Cancer Model of Care, written
by more than 45 leading cancer
clinicians and endorsed by
Professor Sir Mike Richards,
National Clinical Director for
Cancer and End of Life Care,
was published in January 2011.
This agreed model of care sets
out how providers could work
together in provider networks
or ‘integrated cancer systems’
to deliver seamless cancer care.
Work is under way on
the development of two such
systems – the London Cancer
Alliance (LCA) West and South
(southeast, northwest and
southwest London) and
04 RM MAGAZINE
London Cancer (northeast and
north central London). The
Royal Marsden sits within the
LCA, and our Chief Executive,
Cally Palmer, is leading the
development of these proposals.
The best patient experience
The LCA’s aim is to reduce the
number of preventable cancer
deaths in London, estimated
by Professor Richards to be
1,000 lives per year – or 600
for the LCA area.
“With 16 hospitals, two
academic health science centres
and one of the country’s leading
cancer hospitals and research
centres, we will ensure that care
is localised wherever possible
for common cancers and
centralised where appropriate
for rarer cancers, to improve
outcomes and ensure that
we deliver the best patient
experience,” said Cally Palmer.
“The LCA will work to improve
access to screening and
diagnostics to ensure treatment
begins at an earlier stage, and
seek to redress the imbalance
that currently exists across
London. Better access within
the system to clinical trials for
all patients will advance cancer
care for all in our community,
and improve outcomes and
the patient experience.”
Equal access to care
To deliver on these objectives,
certain challenges need to
be overcome, including the
unique demographic profiles
and socio-economic deprivation
in the communities we cover.
There is a poor uptake of
screening and an even poorer
recognition of the early signs
and symptoms of cancer,
resulting in late presentation.
This results in an inequality
of outcomes and experience of
cancer patients across London.
There are solutions. By
promoting the prevention
and early detection of cancer,
and by supporting GPs, we
can influence public health
messaging and improve
outcomes while offering equal
access to excellent clinical care
and unified world-class research.
A Clinical Service Plan has
been developed and all the
partners are working on the
governance model and metrics
to ensure that this system can
deliver results.
We will improve
outcomes and
deliver the best
patient experience
CALLY PALMER, CHIEF EXECUTIVE,
THE ROYAL MARSDEN
Hospital news
First patients enrol
in personalised
treatment project
Clinicians and scientists at
The Royal Marsden and The
Institute of Cancer Research
(ICR) are participating in a
ground-breaking project that
could lead to personalised
cancer treatment.
The Cancer Research
8.6WUDWL¿HG0HGLFLQH
Programme aims to establish
a world-class NHS genetictesting service in the UK
that will help doctors match
cancer patients to the most
appropriate treatment.
The Royal Marsden and
ICR’s Clinical Director for
Research and Development,
Professor Stephen Johnston,
said: “As individuals with
the same type of cancer may
respond differently to the
same treatment, molecular
diagnostic tools can help
LGHQWLI\ZKRPD\EHQH¿W
from different therapies.
It means treatment can be
tailored to suit individual
needs, rather than using the
WUDGLWLRQDORQHVL]H¿WVDOO
treatment approach.”
Up to 9,000 patients will
WDNHSDUWLQWKHSURMHFW¶V¿UVW
phase, which covers breast,
bowel, lung, prostate, ovary
and melanoma skin cancer.
One of the project’s seven UK
centres, The Royal Marsden
and ICR have produced the
¿UVWUHVXOWVIURPOXQJFDQFHU
patients’ tumour samples.
More than 100 of our patients
have been recruited to the
project so far.
The project follows
The Royal Marsden and
ICR’s existing work on
providing patients with a
routine molecular diagnosis
as part of our personalised
medicine programme.
Centre for Molecular Pathology
TOPPING OUT MARKS
BUILDING MILESTONE
Progress on The Royal Marsden
and The Institute of Cancer
Research’s (ICR) new Centre
for Molecular Pathology (CMP)
in Sutton reached a major
milestone when it was ‘topped
out’ late last year.
The new £9.6-million centre,
expected to be completed this
November, will help advance
cancer research and treatment.
It will include four laboratory
suites and support facilities
with state-of-the-art equipment.
Professor Stephen Johnston,
Clinical Director for Research
and Development at The Royal
Marsden and ICR said: “The
CMP was conceived nearly five
years ago. It’s exciting to think
that later this year it will be up
and running and benefiting
its first patients.”
Dr David Gonzalez de Castro,
Head of Molecular Diagnostics,
whose team will relocate to
the CMP once it is open, said:
“The Royal Marsden and ICR
are leading the way in providing
patients with routine molecular
diagnosis that will help identify
which patients will benefit
from which therapies. This
new centre will drive a move
towards personalised medicine,
bringing scientists and
clinicians together to continue
revolutionising the diagnosis
and treatment of cancer.
“Together with our work
on Cancer Research UK’s
Stratified Medicine Programme
(see left) this is an exciting
time for cancer research, with
the prospect of significant
improvements in patient care.”
Erica at work (above) and
receiving her award (below)
Recognising excellence
ROYAL MARSDEN
RADIOGRAPHER
WINS AWARD
Erica Scurr, Lead MRI
Superintendent Radiographer
at The Royal Marsden, has
received the 2011 Radiographer
of the Year Award for the
London Region. Nominated by
colleagues, she was awarded
the title in recognition of her
excellent work in Magnetic
Resonance Imaging (MRI).
Erica, who is the cross-site
lead for delivering the clinical
and research MRI service,
said: “To be recognised in
this way is a tremendous
achievement. It reflects
positively on the whole imaging
team at The Royal Marsden,
who work very hard to achieve
the highest standards in
imaging and patient care.”
Erica received her award at
a ceremony at the House of
Commons last November.
Professors Stan Kaye (left) and Stephen Johnston of The Royal Marsden and ICR
‘top out’ the Centre for Molecular Pathology in Sutton
RM MAGAZINE 05
Funding future research
HEAD AND NECK UNIT
RESEARCH GRANT WIN
he Head and Neck Unit
at The Royal Marsden,
led by Dr Chris Nutting
and The Institute of Cancer
Research’s (ICR) Dr Kevin
Harrington, has been awarded
a £1.5-million research grant
from Cancer Research UK.
The Clinical and Translational
Research Programme grant
will fund research into head
and neck cancers over the next
five years. The Royal Marsden
was one of only four institutions
out of 80 initial applicants to
be awarded the grant.
The resulting research
will form a series of specific
interrelated projects looking at:
X the use of new radiosensitising drugs
X using new MRI and PET
scanners to more accurately
determine whether radiotherapy
should be delivered to an
individual. This is image-guided
Dr Kevin Harrington (above)
and Dr Chris Nutting (right)
06 RM MAGAZINE
radiotherapy, a state-of-the-art
diagnostic scan that identifies
which parts of the tumour to
concentrate on (for further
details of the hospital’s new
PET scanners, turn to page 10)
X improving understanding of
how normal, non-cancerous
tissues are affected by
radiotherapy treatment.
“A programme grant is one
of the biggest to get, so we are
thrilled we were successful,”
said Dr Nutting. “This gives
us more opportunity to do
further research into head
and neck cancer treatment.
“It is through The Royal
Marsden and the ICR’s
long-standing partnership
that we were in a position to
apply for and win this grant.
Dr Harrington and I are a
double act, bringing together
the two interdependent strands
of clinical practice and science.”
FUNDING FOR
SKIN CANCER
PATIENT TRIAL
The Royal Marsden and The
Institute of Cancer Research
(ICR) are to test an experimental
drug in patient trials to combat
advanced skin cancer, with the
assistance of a £3-million grant
from the Wellcome Trust.
The BRAF inhibitor has the
potential to treat more subtypes
of malignant melanoma than
any other targeted treatments
for this cancer. Scientists also
believe that it will not cause the
serious side effect of squamous
cell carcinoma that has been
linked to an existing treatment.
The Wellcome Trust will work
with The Royal Marsden and
the ICR through its Strategic
Translation Award programme
to further refine the candidate
compounds and take the most
promising ones into clinical trials.
The Wellcome Trust funding
will enable the team in the ICR’s
Cancer Research UK Cancer
Therapeutics Unit to select the
best drug candidate for initial
safety testing and determine
an appropriate dose to give to
patients. Clinicians in The Royal
Marsden’s Melanoma Unit will
then lead the early clinical trials.
The team will also examine the
different types of melanoma
for which the drug is effective,
including whether it can benefit
patients who have relapsed
after taking vemurafenib.
Dr James Larkin from The
Royal Marsden said: “We are
delighted by this partnership
between The Royal Marsden,
the ICR and the Wellcome
Trust, and are thrilled with the
commitment from the Wellcome
Trust to our research.
“We know that BRAF
inhibitors such as vemurafenib
benefit a large number of
melanoma patients with BRAF
mutations, but most patients
become resistant to treatment.
There is, therefore, a need to
develop more effective drugs and
also to target melanomas that
do not have BRAF mutations.”
Hospital news
New drug extends
life for prostate
cancer patients
CLINICAL TRIALS: THE FACTS
What are clinical trials and
what do they look at?
These medical research studies
involve people and look at:
X risks and causes: how
genetics, lifestyle and other
factors can increase people’s
risk of cancer
X preventing cancer: using
drugs, vitamins or diet to
reduce risk
X screening: for people at
higher than average risk,
or for the general population
X diagnosing cancer: new
tests or scans
X treatments: new drugs
or combinations, new types
and methods of giving treatment
X controlling symptoms or
side effects: new drugs or
complementary therapies.
What are their objectives?
They aim to find out if a new
treatment or procedure:
is safe or has side effects
works better than currently
used treatment
X helps people feel better
X has been thoroughly tested –
for example, a new drug is
investigated first in the
laboratory. If it looks promising,
it is carefully studied in people.
X
X
Are there different stages?
There are four phases of trials:
X Phase I trials look at whether
a trial treatment is safe or has
any harmful effects – as well
as the best dose to use
X Phase II trials consider how
well a treatment works – only
those that get through these two
phases go into Phase III testing
X Phase III trials test a new
treatment against the existing
standard treatment – if it gives
better results, it may become
the new standard treatment.
Usually, a new treatment has to
go through a few Phase III trials
before doctors are confident
enough to accept it as the new
standard treatment. One good
result could happen by chance
or because of a poorly designed
trial. This is not likely if several
trials have the same results.
X Phase IV trials are carried out
after a drug has been licensed
– information on side effects,
safety and long-term risks and
benefits of a drug is collected.
Most well-planned trials include
studies of impact and side
effects or a ‘quality of life’ study.
How useful are the trials?
Not all clinical trials result in
new, better treatment. Some find
that the trialled treatment doesn’t
work or has worse side effects
than existing treatments. But
this information is still useful
for researchers, doctors and,
ultimately, patients.
A new type of hormonal
treatment has been shown
to extend life for men with
advanced prostate cancer,
according to an interim
analysis of a Phase III trial
jointly led by Professor
Johann de Bono from The
Royal Marsden and The
Institute of Cancer Research.
The once-daily pill, known
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a new class of drugs called
androgen receptor signalling
inhibitors (ARSIs). Prostate
cancer relies on testosterone
to grow, so the drug has
been designed to bind to
the receptors on prostate
cancer cells and block their
interaction with testosterone.
The drug has been
tested on 1,199 men with
advanced prostate cancer
who were previously treated
with docetaxel-based
chemotherapy. Patients
treated with MDV3100 lived
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months longer than those
given a placebo.
“It’s a major advance,”
said Professor de Bono. “Until
recently, men with advanced
disease that had proved
resistant to treatment had no
drug options. Now there are
a handful of drugs for latestage prostate cancer. Five
more months for these men,
who are at a very late stage
RIFDQFHULVDKXJHEHQH¿W´
RM MAGAZINE 07
Hospital news
Arts Forum competition
WINNERS
EXHIBIT
PHOTOS
ast year, the hospital’s
Arts Forum held
a photographic
competition that was open
to patients, their families, carers
and staff. After receiving more
than 240 wonderful entries,
the winners were celebrated at
the opening night of a special
exhibition last November. The
exhibition of 35 images included
the winners and a selection of
the Arts Forum’s favourites from
all of the entries.
Professional photographer
Tim Flach presented Chris
Sargent from Cheam with first
prize and £200 of Jessops gift
vouchers for his atmospheric
black-and-white mountain
scene. Sam Murphy from
Wallington came second and
won £100 of Jessops vouchers
for his beautiful picture of a
harbour viewed through a
window. In addition, The Royal
Marsden’s Sue Alexander,
Principal Biomedical Scientist
and Pathology Services
Manager, and Douglas Davies
from Coulsdon were both
awarded runners-up prizes
of £50 worth of vouchers.
The Arts Forum’s own award
for their favourite image was
awarded to Hannah Wright,
08 RM MAGAZINE
aged 15, for her enchanting
photograph of a young child
in a field of yellow flowers.
The Arts Forum would like
to say a huge ‘thank you’ to
everyone who entered, and
hopes they will look out for
future competitions. Thanks
also to judges Tim Flach,
Giles Christopher and David
Cockcroft; the Photography and
Printing Department for printing
the photographs; the Works
Department for help hanging
the exhibition; and the Mulberry
Tree Café for hosting the event.
Clockwise from top: Chris Sargent’s winning
mountainscape; Sam Murphy’s harbour view won
second prize; Hannah Wright’s image of a child in
a Àeld; Tim )lach right congratulates winner
Chris Sargent at the opening of the exhibition
Hospital news
Excellence in care
COMMITTED
TO CARING
The Royal Marsden is meeting
all the essential standards of
quality and safety, according to
a review carried out by the Care
Quality Commission (CQC) last
October. The review stated that
patients at the hospital have their
privacy and dignity maintained
and that their independence is
respected. Patients also told the
CQC that staff are friendly,
helpful and responsive to their
needs – most had received
enthusiastic and committed care
of an excellent standard. The
Royal Marsden was also praised
for its safe quality care, treatment
and support due to an ongoing
monitoring process.
OUR RADIO’S
NEW PATRON
Nicholas’ infectious
enthusiasm and his
experience will be
of immense value
JASON REYNOLDS, CHAIRMAN, RADIO MARSDEN
Radio Marsden is delighted
that BBC newsreader Nicholas
Owen (left) has agreed to
become its new patron.
Following in the footsteps of
Gary Lineker, John Cleese, Peter
Sellers and HRH The Prince
of Wales, Nicholas joins the
station after a long association
with the hospital, presenting
shows and meeting patients.
Nicholas spent 17 years as a
newspaper journalist and joined
the BBC in 1981. He went on to
spend 23 years at ITN, working
as anchor for News at Ten
and Channel 4 News, and as
ITN’s royal correspondent.
He rejoined the BBC in 2007.
Radio Marsden Chairman
Jason Reynolds said: “I’m
delighted Nicholas is joining
us as our patron. His infectious
enthusiasm and his experience
will be of immense value.”
Readers love RM magazine
Thanks to all who took part in our RM
readers’ survey last year. It produced some
very helpful feedback, and we were delighted
to see that, overall, our readers are very
happy with RM magazine and its content.
Respondents thought that the magazine was
a good way to receive information about
the hospital, with most saying it was easy
to read, informative and useful, with a good
balance of contents. A few requested more
coverage on research projects and some
real-life stories, so look out for these in 2012.
Congratulations to Sally Moore, Nursing
Research Fellow, who was the lucky winner
of the £20 John Lewis voucher.
RM MAGAZINE 09
Hospital news
Royal praise
for our food
At a reception hosted by
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Clarence House in December,
The Royal Marsden was
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by the Soil Association. The
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JURZLQJQXPEHURIKRVSLWDOV
VHUYLQJPRUHORFDOIUHVK
RUJDQLFDQGKHDOWKLHUIRRG
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KLJKHVWDFKLHYLQJKRVSLWDO
WUXVWVWKHHYHQWFHOHEUDWHGWKH
EHVWRI%ULWLVKKRVSLWDOIRRG
&KLHI2SHUDWLQJ2I¿FHU'DYLG
3UREHUW)DFLOLWLHV0DQDJHU
*DU\%XUNLOO&RQVXOWDQW
Dietician Dr Clare Shaw and
&DWHULQJ0DQDJHU0U*DUHWK
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Royal Marsden.
Sourcing ethical foods
WINNING WAYS WITH
ANIMAL WELFARE
The Royal Marsden was
among 40 hospitals,
educational centres and
local councils to be awarded
a Good Farm Animal Welfare
Award. The award was
presented by Compassion in
World Farming for our efforts
to help improve the welfare of
millions of farm animals.
The awards’ three categories
– Good Egg, Good Chicken and
Good Dairy – recognise an
organisation’s commitment to
improving the lives of animals
by sourcing only higher-welfare
eggs, chicken or dairy produce
for their catering. We were
the only NHS hospital to win
a Good Chicken Award.
Denise Satterwaite, Catering
Operations Manager, said:
“We believe it’s essential to
consider the wellbeing of the
animals we source for patient
and staff meals. For the past
three years, we have provided
free-range eggs in our
restaurants and only organic
milk to our patients. We will
continue the drive towards
sourcing ethical and
sustainable food products.”
The Good Farm Animal
Welfare Awards have been
presented to the food industry
Scanner for Nuclear
Medicine Unit
A new £3.2-million Nuclear
Medicine Unit opened at
the Chelsea hospital in
December. The new unit
means that patients can now
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nuclear SPECT/CT and
PET/CT scanners without
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hospitals. Housed on the
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by the NHS.
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years,” said Bernadette
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10 RM MAGAZINE
across Europe since 2007. The
Royal Marsden was awarded
the Good Egg Award in 2010.
Over 265 million hens,
chickens, pigs and dairy cows
and calves benefit each year
as a result of winners’ policies.
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WKRXJKW
18
107
chefs and
other catering
staff work across
both Royal
Marsden sites
667,000
customers a
year are served
at Sutton and
402,000
customers a
year are served
at Chelsea
180,000
pints of milk are
used in a year
Catering Operations
Manager Denise
Satterwaite and
Catering Manager
Gareth Ferguson
receive the Good
Chicken Award
Hospital news
Award for online
learning resource
An e-learning module,
Mesothelioma Practice in
Cancer Care, developed by
the School of Cancer Nursing
and Rehabilitation, has been
named Best Professional
Education Initiative in
2QFRORJ\DWWKH3¿]HU
Excellence in Oncology
Awards 2011. For the past
six years, the awards have
recognised and rewarded
best practice in oncology
management, education and
patient care across the UK.
Now in its third academic
year, the school’s e-learning
module is the result of the
dedicated teamwork of
Patricia Hunt, Lecturer
3UDFWLWLRQHU/L]'DUOLVRQ
Macmillan Consultant Nurse,
Mesothelioma UK; Sally
Moore, Nursing Research
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Knowledge Resources
0DQDJHU'DYLG*OHGKLOO
VLE Administrator; and
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'HYHORSPHQW)DFLOLWDWRUIRU
e-Learning and IT.
7R¿QGRXWPRUHDERXW
this degree- and master’slevel stand-alone module,
contact the school at
[email protected].
From left: Mr David Dunlop, Clinical
Director, Specialist Oncology Services,
West of Scotland Cancer Centre,
Gartnavel General Hospital; Sally
Moore, Nursing Research Fellow, The
Royal Marsden; Liz Darlison, Macmillan
consultant nurse, Mesothelioma UK;
Nicholas Owen, broadcaster; Robert
'D\+HDGRI3À]HU2QFRORJ\8.
Refurb update
WALLACE WING REVAMP
NEARS COMPLETION
he new entrance to
the Wallace Wing at
our Chelsea site
now provides an improved,
enlarged waiting area, more
toilet space, a new transport
office, a discreet interview
room and a new reception
with ‘meet and greet’ facilities.
When complete, the whole
area will reflect the improved
quality of recently refurbished
hospital departments. The
Mulberry Tree Coffee Shop
remains but with better
seating facilities, while the
Radiotherapy Department on
the lower ground floor also
has a new reception with
T
larger waiting areas to improve
the patient experience.
The entrance will incorporate
an interactive information
kiosk, which will enable
patients and visitors to search
for and print directions and
The new entrance
will incorporate
an interactive
information kiosk
and digital screens
other information. In addition,
digital information screens
have been installed here and
at other key entrances and
waiting areas, so the Trust
can ensure that patients and
visitors are kept informed about
news and Trust information.
The screens have been kindly
funded by The Friends of The
Royal Marsden.
Patients and visitors will soon
be able to use the new entrance,
at which point the temporary
entrance will be closed off and
the final phase of work carried
out. The project is currently on
schedule, with the whole area
due for completion by Easter.
RM MAGAZINE 11
Gastro-intestinal and
Breast Clinical Oncologist
Dr Diana Tait
Cancer focus
BOWEL CANCER SPECIAL
A multi-faceted
approach to treatment
The Royal Marsden leads the way in bowel cancer care. We talk to four
of the hospital’s leading clinicians about their pioneering work
he use of radiotherapy in the treatment
of bowel, particularly rectal, cancer can
be highly effective but it can also result
in long-term side effects that affect life quality.
Dr Diana Tait, Gastro-intestinal and Breast
Clinical Oncologist, leads a team working to
make sure that when radiotherapy is given
it is done so having carefully selected those
patients that have most to gain from it, rather
than using it as a standard treatment.
“At The Royal Marsden, we are using
imaging, particularly MRI scans, to select
patients whose tumours show high-risk
features and who are most likely to
benefit from radiotherapy,” says Dr Tait.
“Conversely, we try to avoid giving it to
patients whose tumours are low risk and
for whom the risks of radiotherapy could
outweigh any potential benefits. Our patients
are treated with either conformal radiotherapy
or intensity modulated radiotherapy (IMRT).”
Pioneering trials
Dr Tait’s team is co-ordinating two national
multi-centre trials looking at the effects of
radiotherapy in rectal cancer. The first (The
Deferral of Surgery Trial) looks at deferring
or avoiding surgery for patients who have
an excellent response, in terms of tumour
shrinkage following pre-operative treatment,
and for patients for whom surgery would
involve a permanent stoma.
“Avoiding surgery is not the standard
treatment,” explains Dr Tait. “We monitor
patients very closely within the trial. We try
to avoid patients having surgery after
chemoradiation where there is no sign of
cancer when the surgical specimen is
examined under the microscope. Tumour
disappearance is seen in up to 20 per cent
of patients following chemoradiation: our
aim is to detect these patients before
surgery and avoid surgery if possible.
The second trial (The Timing of Surgery)
looks at the best time to carry out surgery
after chemoradiation for rectal cancer.
About six weeks after chemoradiation is
the standard, although many surgeons leave
it to 10 weeks or more, aiming to operate
at a time of maximum tumour shrinkage.
“Our trial aims to establish the best time
for surgery,” says Dr Tait. “By comparing
surgery at six weeks with surgery at 12
weeks, we hope to confirm whether it is
advantageous or detrimental to select one
or the other time.
“Our work has been driven by patient
choice. Before our trials started, some patients
who responded well to chemoradiotherapy
were unwilling to proceed to surgery. We
hope to establish which patients can rely on
chemoradiotherapy alone and which must
still undergo surgery. Outcomes for patients
with rectal cancer focus on tumour control
but the physical and psychological effects
of treatment are also taken into account in
the decision-making process.”
We hope to establish
which patients can rely on
chemoradiotherapy alone
DR DIANA TAIT, GI AND BREAST CLINICAL ONCOLOGIST
RM MAGAZINE 13
Cancer focus
Pioneering imaging trials
CASE STUDY:
John Parnell,
34, manager
“I was diagnosed
with bowel cancer
seven years ago.
I was 27 years old,
Á\LQJKHOLFRSWHUVLQ
the army. I started
WRH[SHULHQFH
bleeding and
mucus in my stool
but didn’t go to my
*3IRUDERXWÀYH
months. Following
diagnosis, I was
sent to The Royal
0DUVGHQWRH[SORUH
DOORSWLRQVDQG
,ZDVWKHÀUVW
SDWLHQWLQWKH
country to go on
the Wait and See
Trial. The trial
used imaging,
FKHPRWKHUDS\DQG
UDGLRWKHUDS\UDWKHU
WKDQDQRSHUDWLRQ
to remove the
tumour. After a
three-month course
RIFKHPRWKHUDS\
the tumour had
shrunk. I then
KDGUDGLRWKHUDS\
and, due to the
intensity of the
treatment, I was
told that I would
be left infertile,
VR,WRRNXSWKH
offer of banking
VSHUP)RUWXQDWHO\
I didn’t need it.
My wife Anna and I
conceived naturally
DQGRXUÀUVWEDE\
is due in February.”
The Royal Marsden has been at the
forefront of rectal and colorectal cancer
imaging research for a number of years.
Dr Gina Brown, Consultant Radiologist,
explains how attention to detail can make
a difference to the patient’s treatment plan
and has, in many cases, allowed them to
avoid the need for a permanent stoma.
Dr Brown is chief investigator for the
pioneering multi-centre MERCURY staging
study in rectal cancer. The trial resulted in
widespread adoption of MRI techniques for
rectal cancer and practice changes in the
UK and overseas, such as more selective
use of radiotherapy.
“Before the results of the MERCURY trial
research were known, clinicians were
routinely irradiating patients with rectal
cancer and, in many cases, removing the
whole rectum, often resulting in a permanent
colostomy bag for the patient,” explains
Dr Brown. “At The Royal Marsden, patients
are fortunate to have research-validated
knowledge of precise image-based planning,
so the unnecessary side effects of extra
treatment, such as radiotherapy or extensive
surgery, could be avoided, thus enabling
patients to lead a better quality of life. This
approach has now been rolled out through
national radiology training workshops and
clinical teams are now also starting to gain
this knowledge.”
Following the success of the MERCURY
trial, Dr Brown and her team have moved
her research forward to predict how well
patients will do based on the MRI scans.
“The results of our studies analysing the
long-term outcomes of patients in our trials
have confirmed that careful interpretation
of imaging can correctly identify patients
who will be cured by surgery alone,” says
Careful interpretation
of imaging can correctly
identify patients who will
be cured by surgery alone
DR GINA BROWN, CONSULTANT RADIOLOGIST
14 RM MAGAZINE
Dr Brown. “On the other hand, by
identifying those patients at high risk of
the tumour coming back, we can intensify
treatment and follow up, to try to prevent
secondary tumours and recurrences.
“We also have exciting new
developments looking at the possibility
of patients avoiding surgery completely
in a new trial being pioneered at The
Royal Marsden,” she explains. “We identify
the patients that have had an excellent
response to treatment and, if they have no
visible tumour on MRI, we can enrol them
into a surveillance programme aimed at
safely avoiding surgery, thus preserving
their quality of life.”
Consultant Radiologist
Dr Gina Brown
Cancer focus
Bowel cancer
86%
Professor
Paris Tekkis
of cases of
patients are over
60 at the age
of diagnosis
1.24
million new cases
of colorectal
cancer were
diagnosed in 2008
3rd
most common
cancer in men
1in14
lifetime risk of
diagnosis in men
1in19
lifetime risk
of diagnosis
in women
Life-saving surgery
Up until five years ago curative surgery was
not an option for patients with advanced
bowel cancer in the pelvis. Since then,
Professor Paris Tekkis has performed 100
pioneering pelvic exenteration operations
at The Royal Marsden: revolutionary
surgery that offers hope to many patients
who previously would have been given
standard life-prolonging chemotherapy
and radiotherapy treatment.
Patients who are offered the pelvic
exenteration operation are identified during
The Royal Marsden’s Multi Disciplinary
Meetings, a weekly get-together of a
specialist team of oncologists, radiologists,
pathologists, surgeons and nurses.
The complex operation involves removing
the rectum and other pelvic organs
including the bladder and part of the bony
spine in order to achieve a cure. A team of
up to six specialists can be present during
the 12-hour operation, including colorectal,
urology, gynaecological, spinal, oncology
and plastic surgeons. Reconstructive
procedures are then used to replace the
bladder and rectum.
“There are side effects from the operation
but it varies from patient to patient,” says
Professor Tekkis. “Some experience bladder
or sexual dysfunction, but for most people
the chance of life is more important than
the inconvenience of a bag.”
One third of patients who are suitable
for the operation have a curative result.
“I have no doubt that our cure rate will
increase further in the future, which is
really exciting,” says Professor Tekkis.
“We will be able to use new chemotherapy
agents and radiotherapy, such as CyberKnife,
to get the tumour under control before or
after operating. I am sure that we will
soon be achieving a 50 per cent cure rate.
“We select patients based on tumour
location and the presence or absence of
metastatic disease. There are no real age
barriers. We have had patients who are
in their 80s and as young as 35.
“Every operation is customised to
each individual patient and meticulously
undertaken by a dedicated specialist team
and looked after by a top class anaesthetic
and intensive care team. This is what
makes it so special and so successful.” rm
Sequisti inct
cone pratus
maximo bero
plabo. Am qu
CASE STUDY:
Andy Gibson, 53, musician
“I was diagnosed with bowel cancer in
January 2010 at Kingston Hospital. I had
H[SHULHQFHGÁXOLNHV\PSWRPVIRUWKUHH
months before I actually went to the doctors.
“I went to The Royal Marsden at Sutton for
chemotherapy and radiotherapy. Professor
Paris Tekkis didn’t initially think I would
be suitable for the pelvic exenteration
operation because the cancer had spread
into the lymph nodes and perhaps even the
liver. However, after more chemotherapy at
Kingston Hospital, I was able to undergo the
operation. It was the only option for me to
try to get rid of the cancer entirely.
“My operation lasted 16 hours and involved
four consultant surgeons and their teams.
7KHSODVWLFVXUJHRQVSHQWÀYHKRXUVZRUNLQJ
on me. I would like to take this chance to
thank Professor Tekkis and everyone on his
team for their wonderful work. It has been
four months since my operation and I am
slowly getting my life back together. I’m now
back at work playing the trumpet again.”
RM MAGAZINE 15
Cancer in focus
Q&A
BOWEL
CANCER
Dr Sheela Rao, Consultant Medical
Oncologist, Gastrointestinal Unit,
discusses bowel cancer
as an emergency with bowel obstruction.
In addition, bowel cancer can present
asymptomatically, with iron deficiency
anaemia found on blood tests.
How is it diagnosed?
Diagnosis is usually made by a combination
of clinical examination, blood tests and a
colonoscopy and biopsy. A colonoscopy is a
flexible tube examination of the entire large
bowel, and a biopsy is a needle test to take
a tissue specimen of the tumour. A CT scan
is usually performed to assess the extent of
the cancer (staging), and for rectal cancer an
MRI scan is necessary to give more detail
about the cancer before treatment.
Who does it affect?
Bowel cancer is a disease of the developed
world, with a low incidence in developing
countries. About 86 per cent of patients
are over 60 at the age of diagnosis, but the
incidence in patients under 50 is increasing.
It affects men and women in equal
proportions up until the age of 50, and there
is a higher propensity in women in later life.
How common is it?
What is bowel cancer?
Bowel cancer describes any cancer occurring
in the colon (large bowel) or rectum. This
type of cancer is known as adenocarcinoma.
What causes bowel cancer?
Most bowel cancers arise from adenomas
(small polyps or benign growths) in the
colonic mucosa. However, not all adenomas
will transform into cancers. The main risk
factors for malignant change in these polyps
include size, type of appearance and
dysplasia (the proliferation of abnormal
immature cells). Patients with inflammatory
bowel disease have a higher propensity for
bowel cancer, and risk factors for sporadic
bowel cancer include smoking, alcohol,
obesity, low levels of exercise and low-fibre
diets. Approximately five per cent of all
colorectal cancers can be attributed to
a hereditary genetic predisposition.
What are the symptoms?
The signs and symptoms of bowel cancer
include: a persistent change in bowel
habits, rectal bleeding, abdominal pain,
fatigue and unexplained weight loss, or
16 RM MAGAZINE
Worldwide, an estimated 1.24 million new
cases of colorectal cancer were diagnosed
in 2008. It is the third most common cancer
in men, accounting for 663,000 or 10 per
cent of total worldwide cases, and the
second most common in women, with
571,000 or 9.4 per cent of total worldwide
cases. Approximately 40,000 new cases of
bowel cancer (two-thirds colon and one-third
rectum) are diagnosed in the UK each year.
The lifetime risk for men of being diagnosed
with colorectal cancer in the UK is estimated
to be one in 14 and one in 19 for women.
How is it treated?
The mainstay of treatment for localised
bowel cancer is surgery. Chemotherapy is
sometimes given after surgery when cancer
has spread to the lymph nodes. Rectal
cancer is often treated with a combination
of chemotherapy and radiotherapy initially
to help shrink the tumour before surgery.
For patients with widespread or advanced
cancer that has spread beyond the bowel,
chemotherapy, together with a biological
targeted agent, is the treatment of choice.
In some cases, where the bowel cancer
has spread to the liver or lungs, it may be
possible, after chemotherapy, to surgically
remove the tumour deposits in the liver
or lungs, thus improving the long-term
outcome. There are also localised methods
including radiofrequency ablation (targeted
heat therapy generated from high-frequency
alternating current) that can be used in
some cases where the disease has spread
to the liver and lungs.
Is any interesting research being
carried out at The Royal Marsden?
We have several ongoing trials that are
looking at new targeted agents and
chemotherapy. Some of these trials run
in parallel with research conducted at The
Institute of Cancer Research using tumour
tissue and blood samples to learn more
about tumour biology and identify potential
new targets. Newer radiotherapy techniques,
including CyberKnife and innovative surgical
approaches to reduce length of hospital
stay and complications, form part of our
extensive research portfolio in bowel cancer.
CASE STUDY:
Linda Maule, 65, retired
“In 2007, after 10 years of intermittent IBS,
I was sent for a colonoscopy. I was diagnosed
with bowel cancer and referred to The Royal
Marsden for possible radiotherapy prior
to surgery. This was not seen as the best
option, so I had immediate surgery to remove
the cancer and insert a colostomy, followed
by six months of chemotherapy.
“In 2008, I had my colostomy reversed.
7KLVZDVDYHU\GLIÀFXOWWLPHDVP\ERZHO
had to learn how to function again. I couldn’t
have got through it without help from my GP
and her nursing staff.
“A routine CT scan in 2009 showed that
the cancer had returned, this time to my
liver and both lungs, so I was transferred
to Dr Sheela Rao at The Royal Marsden. I was
treated with drugs and chemotherapy before
surgery and further chemotherapy.
“Since then, I have had further CT scans
and three-monthly check-ups with Dr Rao,
all of which have shown positive results.
“I cannot praise the consultants, surgeons
and medical staff highly enough. The ethos,
encouragement and support at The Royal
Marsden is tangible the moment one steps
through the glass doors.”
BBC Horizon documentary
The Horizon team on
location at the hospital
Lights,
camera,
action
Our pioneering research
and treatments made us
the perfect location for the
BBC’s Horizon series to film
a documentary about cancer
ast summer, the award-winning BBC2
documentary series Horizon followed
the work of The Royal Marsden and our
academic partner, The Institute of Cancer
Research (ICR), in an hour-long programme
entitled ‘Horizon: Defeating Cancer’,
to be broadcast this spring. The film
focuses on the organisations’ pioneering
bench-to-bedside approach to cancer
medicine, as well as state-of-the-art
treatments used at The Royal Marsden.
“We wanted to find somewhere to film
that would enable us to learn about cuttingedge research and see how it was benefiting
patients,” explain BBC producers Diana
Hill and Naomi Law. “We approached
The Royal Marsden because of its reputation
as a leading cancer hospital and a place that
specialises in researching new treatments.”
The documentary focuses on three areas:
breakthroughs in life-extending drugs for
advanced melanoma patients; state-of-theart radiotherapy treatment CyberKnife; and
robotic surgery for prostate cancer patients,
using the pioneering Da Vinci S system.
“We felt privileged to get a behind-thescenes view of the work of the extraordinarily
caring hospital staff,” add Diana and Naomi.
“We enjoyed getting to know them over
the four months of filming. They made us
feel welcome, despite us pointing cameras
at them, and were keen to tell us and the
Horizon audience about the innovations
in cancer care they are helping to pioneer.
“The hospital staff and press office
helped us to identify patients who were
undergoing new treatments being trialled.
We’re grateful that some were happy to let
us film their treatment and touched to be
allowed into their lives at such a difficult
time. Their stories help to give viewers an
insight into the future of cancer treatments.
“Filming in a hospital was tricky as we
had to put the needs of patients and staff
first. Fitting in interviews in busy wards
around consultations put our directing and
producing skills to the test! However, it has
been worthwhile and we hope this film will
help people to understand more about
cancer and new ways of treating it.” «
RM MAGAZINE 17
Filming at the hospital
was trickier than usual
because we had to put
the needs of patients and
VWDII¿UVWDWDOOWLPHV
DIANA HILL AND NAOMI LAW, BBC PRODUCERS
Dr James Larkin –
breakthrough
treatment for
advanced
melanoma
A Phase III study led
in the UK by Dr James
Larkin and his team at The Royal Marsden
has brought about a major breakthrough
in the treatment of advanced melanoma.
The results show that the pill vemurafenib
extends overall survival in advanced
melanoma patients compared to standard
dacarbazine chemotherapy. Around half of
patients with advanced melanoma have the
BRAF genetic mutation which drives the
cancer cells to grow and spread. The new
pill targets and blocks the mutated BRAF
protein, causing tumours to shrink. This
new drug is an example of the collaborative
relationship between The Royal Marsden
and The Institute of Cancer Research (ICR).
The BBC filmed with Rosemary Reid,
a patient from the melanoma clinic, from
June to September, monitoring the progress
of this new drug. Filming took place in the
clinics with consultants and research nurses,
and at the patient’s home.
Dr Nick Van As
– CyberKnife
The BBC had
unprecedented access
to CyberKnife when
it performed its first
treatment on a patient at
The Royal Marsden. Having filmed during
several clinics and with several patients to
start with, the BBC decided to focus on
Ray Dean, who was to be the first patient
treated with CyberKnife at The Royal
Marsden. The BBC crew filmed the extensive
planning that took place over the days
18 RM MAGAZINE
preceding the ‘go live’ date, as well as
on the day itself. The Royal Marsden was
one of the first NHS Trusts to install the
latest model of the robotic tool, which
offers precision-targeted cancer treatment.
Its robotic arm and image sensors track
a moving target, delivering hundreds of
radiation beams from various angles,
with pinpoint accuracy.
Mr Chris Ogden
– the Da Vinci S
The Da Vinci S has
been termed the
‘vanguard’ of surgical
treatment for prostate
cancer. It can cut and
manipulate tissue through a tiny hole, and
so reduce the pain and blood loss caused
by open surgery. The Da Vinci S, funded
by The Royal Marsden Cancer Charity,
operates via a keyhole camera in the
abdomen which magnifies the patient’s
insides by ten. The BBC crew filmed while
Consultant Surgeon Mr Chris Ogden and
his team performed the operation on
Philip Gerrard. A major benefit of this
advanced keyhole surgery is that the
patient’s hospital stay and recovery time is
dramatically reduced compared to normal
surgery. Philip was filmed walking out of
the hospital to go home the next day. rm
From above: BBC
producers Diana Hill
and Naomi Law outside
The Royal Marsden
DQGÀOPLQJDVFHQH
BBC Horizon feature
project. We were not the only project being
filmed within the Trust, but were the only
one in which the story was unfolding live.
:KDWZHUHWKHELJJHVWFKDOOHQJHV"
Q&A
HELEN
TAYLOR
CyberKnife’s Lead Radiographer talks
about her experiences of taking part
in BBC2’s Horizon documentary
+RZGLG\RXIHHOZKHQ\RXZHUH¿UVW
told about the BBC Horizon idea?
Excited and pleased. I was proud to be part
of something that was going to demonstrate
the technology we have. It was fortuitous
that our project was happening when the
Horizon team came, and meant they would
film the first patient treated by CyberKnife.
I am used to professional visitors observing
treatment techniques, and even being
filmed, but this is usually with actors.
The crew didn’t want us to ‘stage’ anything,
but we couldn’t let them film the patients’
actual treatment either, so we worked out
how to do that without contravening any
privacy or dignity issues.
:KDWZHUH\RXUH[SHFWDWLRQV"
I wanted us to be able to deliver the treatment
on the day as if the film crew were not there.
Our thorough training on the new equipment
gave us the confidence to deliver the treatment
as planned, but I didn’t want anyone to be
nervous because of the film crew. They
filmed us talking to our patient prior to
treatment and walking down to the unit
before they left us. They recorded images
from the CCTV cameras that monitor the
patient, so they got all the movements of
CyberKnife as it delivered treatment, without
being intrusive to the staff or patient. The
crew returned as soon as the treatment had
finished, and spoke to us and the patient
as we walked back to the reception area.
Filming always seemed to take longer than
we thought it would and it also meant there
were a lot more people around than usual.
'LG\RXNQRZ«
Horizon is the
BBC’s long-running
popular science
and philosophy
documentary series.
X
7KHÀUVWSURJUDPPH
‘The World of
Buckminster Fuller’
was broadcast
on 2 May 1964 and
explored the work
of inventor Richard
Buckminster Fuller.
X
Did you enjoy it?
Yes. It was quite draining, and I certainly
had butterflies about it, but overall it was
a great experience. The whole CyberKnife
team worked really well together and the
Horizon team were supportive and put us
all at ease. I hope we have demonstrated the
professionalism of The Royal Marsden, and
that it is a warm and caring place to be treated.
Horizon has run for
48 series and 1,104
episodes.
X
Horizon’s audience
has risen from
between 50,000 and
150,000 during the
1965/66 series to over
2.5 million in today’s
multi-channel TV
world.
X
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Our first patient, Ray Dean, was so relaxed
and calm – a natural in front of the camera.
He was so happy to be part of the first group
of patients. CyberKnife came along just at the
right time, because without it he would not
have been able to have any treatment. On
the day, his wife and daughter were really
overwhelmed as we walked him down to
the unit for his treatment – they were just so
grateful he got the excellent care he needed.
Ray Dean, the
Àrst Cyber.nife
patient
A typical episode
takes between
ÀYHDQGVL[
months to make.
X
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SDUWRIVRPHWKLQJWKDW
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HELEN TAYLOR, LEAD RADIOGRAPHER, CYBERKNIFE
:KDWZDVWKH¿UVWWLPH¿OPLQJOLNH"
The crew were very relaxed and easy to
work with, and very excited about our
RM MAGAZINE 19
Prayers in the chapel,
entertaining in the
Oak Centre for
Children and Young
People, and chatting
with hospital staff and
patients: all in a day’s
work for Reverend
John McLuckie
20 RM MAGAZINE
6WDIISUR¿OH
A DAY IN THE LIFE
5HYHUHQG-RKQ0F/XFNLH
b
eing able to help patients come
through a life-changing experience is
a wonderful job. I am one of two
full-time Church of England chaplains at the
hospital, and our role is to support patients
by listening and encouraging them to be
honest about their feelings. Chris Lee, our
Senior Chaplain and a Baptist minister, is
based in Sutton and we have part-time Free
Church, Catholic and Muslim chaplains,
and other faith representatives on call.
$IULHQGO\IDFH
My day usually starts at 8am with admin,
followed by prayers in the chapel at 9.30am,
which anyone can attend. I have weekly
meetings with clinical staff to find out which
patients would like or may benefit from a
visit during my call rounds. Most patients are
happy to talk to me but, after an initial hello,
I can generally tell by their reaction if they
want a chat. I think patients feel they can
trust me and confide in me, and it’s a relief
for them not to have to talk to me about their
treatment, as they do with their clinicians,
family and friends. I’m also one of the few
people here who won’t stick a needle in them!
$V\PSDWKHWLFHDU
Patients have a lot to deal with when they
are being treated for cancer. They generally
swap busy lives for ones focused on their
treatment and have to sit for long periods
doing very little. I can help nurture that
change. I spend 80 per cent of my time
listening to patients, and the rest talking
to them. Some worry about their families
and friends, and hold back from telling
them how they are feeling. With me, they
can say anything. Some patients have
specific questions about their faith, others
start to re-explore their beliefs when ill.
Unfortunately, I’m not able to give simple
answers to their questions and sometimes
I’m faced with people who are angry with
God. I always acknowledge what they are
saying and am sympathetic.
One of the most challenging parts of my
role is when patients are dealing with the
end of their lives. It’s remarkable that many
find a sense of peace. They spend a lot of
time talking to me about unresolved issues,
and I have also helped them by organising
special events, such as a wedding or a
christening service, before they pass on.
+LWWLQJWKHULJKWQRWH
My passion for music also helps me in my
role. I feel people respond to music and,
emotionally, get a sense of peace. During
one call round, a lady told me she liked the
violin so, on the next visit, I played the fiddle
for her. As well as conducting seasonal
events and lunchtime weekly services in
the chapel, I also pop in to see the younger
patients in the hospital’s Oak Centre
for Children and Young People once a
month and play the guitar at their parties.
Sometimes they’re quite shy, but after a
few nursery rhymes, they usually enjoy it. rm
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,IHHOSHRSOHUHVSRQGWRPXVLFDQG
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RM MAGAZINE 21
Celebrating our shining stars
The Royal Marsden’s annual staff awards ceremony was a night to remember
he Royal Marsden held its annual
staff awards ceremony at the end
of 2011, when colleagues from
across the Trust were honoured for
their achievements over the past year.
Chief Executive Cally Palmer
presented the awards alongside
Reverend Dame Sarah Mullally, NonExecutive Director, and said that the
night was a great success: “It was a
real inspiration to hear some of the
nominations. Congratulations to
all those who were nominated and
especially to those who won an award.”
PURSUING EXCELLENCE
Beth Jackson, Senior Clinical Nurse
Specialist/Team Leader, Breast Unit
Beth has made continuous improvements
to the quality of care for breast cancer
patients within the unit. These include
helping to initiate two major service
developments: Open Access Follow-Up,
which provides patients with better
quality follow-up services, and the 23
Hour Surgery Pathway, which enables
timely discharge following breast surgery.
28 RM MAGAZINE
ENSURING QUALITY
Michael Borella, Ward Clerk, Markus Ward
Michael has worked at The Royal Marsden
for more than 10 years and always goes
the extra mile. During his time here, he
has taken over many of the clerical
responsibilities carried out by nursing
staff, releasing them for clinical care.
The Haemato-Oncology Research Team
(Leonora Conneely, Gemma Findon,
Emily Blackmore and Lorna Smith)
The team has achieved an incredible
amount in a short space of time. They
have put haemato-oncology back on the
clinical research map, raised standards
and provided strong leadership to those
they have managed and trained.
DRIVING EFFICIENCY
Amanda Dibblin, School Nurse
Team Leader, Merton School Nurses,
Sutton & Merton Community Services
Amanda has worked very hard to get the
Productive Community Services initiative
off the ground. She and her team identify
ways of improving patient care as well as
working smarter to save time and money.
Staff awards
Receiving their awards
from Non-Executive
Director Reverend Dame
Sarah Mullally and Chief
Executive Cally Palmer:
(top row, from left)
Carrie Weller; members
of the Haemato-Oncology
Research Team; Dr James
Larkin; (bottom row,
from left) Lorraine Hyde
and Dr Marina Parton;
Amanda Dibblin
Mikki Grinstead, Principal Diagnostic
Radiographer/Radiology Services
Manager, Radiology; and Bernadette
Cronin, Radioisotope Services Manager,
Nuclear Medicine (now Deputy Divisional
Director, Clinical Services)
At the end of 2010, the downtime due to
equipment breakdowns was considerable.
To maintain services across the Trust,
Mikki and Bernadette put together plans
to form a diagnostic hub, ensuring each
patient receives their scan quickly, which
has enabled efficiency targets to be met.
state-of-the-art facility will enable the
Trust to treat thousands of patients.
BREAKING BOUNDARIES
Dr James Larkin, Consultant,
Skin and Melanoma Unit
An extraordinary young talent, James has
enhanced The Royal Marsden’s reputation
in just a short time and been instrumental
in driving the Skin Unit forward. His work
has won an EU grant, he is the UK lead
for vemurafenib and has a publication on
a breakthrough treatment in melanoma in
the New England Journal of Medicine.
The CyberKnife Project Team (Jim
Warrington, Jim Thurston, Declan
Carter, Steve Butler, Trevor Ramsden,
Karen Rosser, Jan Balyckyi, Helen
Taylor and Sandra Worth)
The team has performed outstanding
work to find a safe and affordable way of
housing the new CyberKnife. This new,
WORKING TOGETHER
Steven Francis, Head of Information,
Information Services
Steven has made a considerable and
sustained contribution to the Trust over a
number of years. He and his team provide
the Trust and external stakeholders with
a service that truly exemplifies the ethos
of excellence at The Royal Marsden.
Rachel Turner, Service Manager;
Lorraine Hyde, Matron; and Dr Marina
Parton, Consultant Medical Oncologist
Rachel, Lorraine and Marina have been
described as a “phenomenal team”. They
aim to make the patient experience at
Kingston’s William Rous Unit of the highest
quality and are a fine example of how
medical, nursing and management staff
can work together to achieve success.
DEVELOPING POTENTIAL
Carrie Weller, Lead Trial Co-ordinator,
Clinical Research & Development
Carrie has shown great commitment to
developing training and mentorship
programmes for clinical research admin
staff. The Royal Marsden’s high retention
of research staff is due in large part to her
work, which contributes to the success of
every research project at the Trust.
RM MAGAZINE 23
Staff awards
OUTSTANDING CONTRIBUTION
Professor Cyril Fisher, Consultant,
Histopathology
Cyril, an international authority on the
pathology of soft tissue tumours, has
made a fantastic contribution to The
Royal Marsden over the past 28 years.
Devoted to the application of new
diagnostic methods in pathology, he
has discovered three soft-tissue cancers
and has 465 scientific publications.
Receiving their awards
from Non-Executive
Director Reverend
Dame Sarah Mullally and
Chief Executive Cally
Palmer: (top row,
from left) Jo Brunt;
Jo Waller and Kelly
McGovern; Chris
Lovelace accepting the
award on behalf
of Steven Francis;
(bottom row, from
left) Professor Cyril
Fisher; Ruth Chandler
24 RM MAGAZINE
UNSUNG HERO/HEROINE
Jo Brunt, Ward Clerk/Receptionist,
Medical Day Unit
The relationships Jo has built with
her colleagues and other departments
have enabled her to synchronise all
aspects of the chemotherapy prescription
process, so that patients on the unit
experience seamless visits.
OUTSTANDING LEADERSHIP
Ruth Chandler, Children’s SLT Service
Manager and Professional Lead, Sutton
and Merton Community Services
Ruth celebrated 30 years of working for
the NHS in 2011. She currently
manages 45 staff across two boroughs
and is steering through changes to
commissioning of services with her usual
professionalism, while maintaining her
own clinical specialism and case load.
Jo Waller and Kelly McGovern,
Sisters/Charge Nurses, Ellis Ward
Jo and Kelly are a dynamic duo who have
inspiring leadership qualities that have
driven a turnaround on their ward – now
a cutting-edge surgical ward delivering
high-quality care to women with cancer.
The following staff were invited on stage in
recognition of completing 20 years’ service
at the Trust: Christina Adusei, Kate
Brennan, Joy Brennan, Milee Choudhury,
Janice Cooper, Patricia Daniels, Amelia
Dionisio, Paul Druce, Terence Elliott,
Timothy Flook, Tracey Gidman, Joanne
Hunt, Richard Keane, Sue McDonald, Anne
McLean, Sara McNeill, Trevor Nash, Jane
Neil, Anna Orlowska, Anne Page, Janine
Salter, Emma Saunders, Nadine Standen,
Jane Tidmas, Jo Vick, Alan Williamson,
Jackie Woodcock and Jonathan Wright. rm
Hospital groups
PCAG AND
THE FRIENDS
CHELSEA AND SUTTON
The Friends of
The Royal Marsden
FOCUS
ON FOOD
Dr Clare Shaw, Consultant
Dietitian, and Gareth Ferguson,
Trust Catering Manager, met
the Patient and Carer Advisory
Group (PCAG) late last year
to discuss catering initiatives
at The Royal Marsden.
For the past few years, the
hospital has been buying in
meals from a cook-chill supplier
but, in the last year, it has been
trying meals produced by the
chefs on site. Concerns about
nutritional content, and a
commitment to buying quality
food from local suppliers when
possible, has driven this change.
New recipes tested on hospital
staff and patients have brought
encouraging results, with high
patient satisfaction and reduced
We’re listening
Helping to improve patient
experience at the hospital,
The Listening Post meetings
enable patients and carers
to meet PCAG members and
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what has worked well and
what hasn’t at the Trust.
The next sessions are on:
Monday 19 March
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Sutton, 1.30pm–3.30pm
Friday 20 April
Outpatients’ waiting room,
Chelsea, 10am–12 noon
Tuesday 15 May
7KH&KHUU\7UHH&DIp
Sutton, 10am–12noon
wastage. The changeover to
Trust-produced foods will be
completed by March 2012.
Other initiatives introduced to
encourage patients to eat include
a wider menu choice, reducing
ward clinical activity to provide
a setting conducive to eating,
and offering patients the choice
of a nourishing drink during the
afternoon tea round. This latter
service has been funded by The
Friends of The Royal Marsden
and is an extra service that is
much appreciated by patients.
HAVING A SAY
ON TRANSPORT
PCAG members have been
working with the hospital’s
Procurement Department on
awarding a new contract for
non-urgent patient transport.
They were involved in the detail
of what firms should provide
in their service, reviewed tender
documents and fed back their
recommendations.
Mandie Adams McGuire,
Chairman of the PCAG, said:
“This is a great example of our
members being involved in a
project from start to finish and
working with other departments
for the benefit of patients.”
The Friends, Chelsea
The Friends of The Royal
Marsden, Chelsea are
continuously working to grow
as an organisation. According
to Jacquie Gulbenkian, Vice
Chairman of The Friends,
recruiting volunteers is the key
to this growth: “It’s been a real
challenge to improve the way
we recruit. The process is now
in line with that for The Royal
Marsden’s employees, which
emphasises the importance the
Trust places on its volunteers.”
The Friends are active in
many ways, including running
The Friends canteen and shop,
shop and hobby trolleys,
arranging flowers, helping
in the pharmacy, tending the
garden and ‘meeting and
greeting’ patients and visitors.
Chairman Wendy Crabb, a
volunteer of 12 years, is at the
forefront of raising The Friends’
profile and fundraising activity
and says: “We’re lucky to have
such loyal and dedicated
volunteers who work tirelessly
to support the Trust. This will
be another busy year for us.”
If you are interested in
volunteering or want to find
out more, please contact
Camilla on 020 7352 3875
or email friends.chelsea@
rmh.nhs.uk
The Friends, Sutton
The Friends’ sales in
Outpatients continue to be very
popular, taking place several
days a week. Items sold are
principally good-quality donated
goods, such as bric-a-brac and
unwanted gifts. Occasionally,
however, craft items that have
been made specially for The
Friends are available.
We have to thank all those
who make such items, but in
particular, we would like to
thank Anne Toms, whose
Easter and Christmas sales are
very popular. She makes all the
items herself and donates all
profits to The Friends. She
has also held sales at Legal
& General, which has matched
the amount raised with its own
donations to The Friends. Her
hard work has raised more
than £14,000 since 2004. Anne
was formerly a member of the
Belmont Crafties, who raised
£7,000 for The Friends.
Jessica Dodwell, Chairman
of The Friends, Sutton, would
also like to thank the many
generous donors and all the
volunteers for their continued
hard work.
For more information about
The Friends at Sutton, visit
www.friendsofthe
royalmarsdensurrey.org.uk
Chelsea Friends: service with a smile
Anne Toms’ handmade gifts
RM MAGAZINE 25
THE ROYAL MARSDEN
CANCER CHARITY
The year ahead
The Royal Marsden Cancer Charity
Following a successful
year for The Royal
Marsden Cancer Charity,
Chairman R. Ian Molson
looks ahead to the
plans and aspirations
for the charity in 2012
ast year was an
outstanding one for The
Royal Marsden Cancer
Charity, with the opening of
the Oak Centre for Children
and Young People (OCCYP),
the installation of our first
CyberKnife machine, and the
inaugural Marsden March.
In 2012, the charity, with its
devoted supporters and donors,
is going to be more important
than ever. In the current climate,
I have no doubt that our reliance
on charitable giving is going to
increase if we are to deliver our
plans for a new imaging floor
at Chelsea and a translational
genetics centre in Sutton.
As the country’s leading
cancer treatment and research
centre, we have a fantastic
opportunity to position ourselves
as the national institution that we
are. Over the past three years,
cancer charities in the UK have
received, on average, £1 billion a
year in giving. Our share of that
is £20 million, or two per cent.
This strikes me as too low for
the country’s leading cancer
centre. We owe it to ourselves,
our supporters and our patients
to try to increase our share of this
support for cancer research and
treatment from the UK public.
We are currently recruiting for
a Director of The Royal Marsden
Cancer Charity. This individual
will help us move towards our
goal, heading up the charity
within the hospital while
representing us to donors across
the UK and the world. This work
will include increasing support
from people who wish to donate
to the hospital’s ongoing work,
such as our cutting-edge research
and ground-breaking treatment,
and changing perceptions of
us as a local charity to one
that has national relevance.
We have wonderful donors
who raise money and donate
to specific projects – for
example, the Critical Care
Unit, the OCCYP and the new
Centre for Molecular Pathology.
We also want to provide more
opportunities to give for those
wishing to support our hospital
and our work in general.
I am confident that with
the work of the charity, the
incredible support of our existing
donors, and new supporters
coming on board this year, the
charity will continue to grow
and support the work of The
Royal Marsden.
We have wonderful
donors who raise
money and donate
WRVSHFL¿FSURMHFWV
R. IAN MOLSON, CHAIRMAN, THE ROYAL MARSDEN
The Oak Centre
for Children and
Young People’s
rooftop terrace
26 RM MAGAZINE
Fundraising
PARACHUTE CHALLENGE
If you want to take part in the
ultimate adrenaline challenge,
here is your chance.
The Royal Marsden Cancer
Charity has places available
for two parachute jumps taking
place at Maidstone Airfield
on bank holiday Monday 7
May 2012 and Saturday 22
September 2012. The May jump
is filling up fast, so we’ve added
a second date in September.
Places are free; all we ask is
that you can raise a minimum
A GREAT DAY OUT
amount of £395 sponsorship
in return for your jump.
Colette Bateman, a nurse on
Bud Flanagan Ward, took part in
the event last year: “As well as
a personal challenge, I wanted
to do a sponsored skydive for
the charity and help make a
difference to our patients. It was
nerve-racking, but one of the
best days of my life.” To join our
team this year, call Sarah Cassidy
on 020 8770 0279 or email
[email protected]
Marsden March 2012
Last year, 2000 patients, their
families and friends joined staff
at The Royal Marsden to take
part in The Marsden March –
a fun 14-mile walk between the
Chelsea and Sutton hospitals.
This year, we doubled the
number of places and had a
fantastic response from our
supporters. We hope to reach
£1 million this year.
Walkers on Sunday 11 March
will include celebrity supporters
such as ex-Busted member
Matt Willis and actor Nathaniel
Parker. In addition to our full
14-mile route, there is a shorter
option that follows the last
five miles of the main route
– a popular choice for families
and teams of all generations.
Our walkers can find training
tips and a fundraising pack
as well as photos and a film
from last year at www.royal
marsden.org/march. To show
your support you can cheer the
walkers along the route or
volunteer to help out at the
event. For details of how you
can still get involved, please
visit the website.
Events calendar
Set yourself a challenge in 2012 and show your
support for The Royal Marsden Cancer Charity.
11 March The Marsden March
7 May Parachuting day
13 May London Olympic Stadia Trekathon
27 May BUPA London 10,000
10 June London Olympic Cycle Ride of Champions
17 June London to Brighton Cycle ride
22 September Parachuting day
For information about other challenge events,
visit www.royalmarsden.org/challenges
CENTRE FOR
MOLECULAR
PATHOLOGY
SPONSOR A
DAY THAT’S
SPECIAL TO YOU
Whether it’s an anniversary,
a birthday or a milestone in
treatment, sponsoring a day at
The Royal Marsden is a great
way to mark a day that’s special
to you and to help the 40,000
patients we see each year. You
can sponsor a day either in your
name or that of a loved one.
The name will be displayed on
our calendar in the reception at
either our Chelsea or Sutton site,
as chosen by you, as well as
featuring on our website on your
chosen day. Look out for the
Sponsor a day leaflet around the
hospital, or sign up online at
www.royalmarsden.org/day
The new Centre for Molecular
Pathology (CMP) is due to open
at the end of 2012. The CMP
will bring leading scientists
together under one roof, so
research discoveries can quickly
be converted into better ways
to diagnose and treat cancer,
making The Royal Marsden’s
vision of personalised medicine
a reality. To donate and to see
a short film about the work
of the CMP, visit www.
royalmarsden.org/cmp
RM MAGAZINE 27
FOUNDATION NEWS
WE NEED
MORE
MEMBERS!
The Royal Marsden needs
your help to increase its
membership so that we can
demonstrate growth to our
regulator, Monitor. It is
also important that the
communities we serve
and to whom we are
accountable are fairly
represented and involved
in the Trust’s development.
Membership is a great way
for anyone interested in what
we do to make a difference.
Sign up as a Member and
you will receive information
about our work, including
a copy of RM. If you want
to get more involved,
you can become a Level
Two Member and receive
invites to special events
and tours, as well as more
frequent communications.
All Members also have the
opportunity to stand as a
Governor on our Council of
Governors at election time.
Members’ Week
To encourage people to join
us, we’re holding our annual
Members’ Week from 27
February to 2 March. New
Members joining that week
will have the chance to win
a prize, and there will be
an incentive for current
Members who recruit new
ones. If you know friends or
family who would like to get
involved, encourage them
to complete an application
form by post or online.
Visit www.royalmarsden.
nhs.uk for more details.
28 RM MAGAZINE
Carer Governor
John Preston
Members’ event
We are planning to hold an
event this summer that will
include a tour of the CyberKnife
Unit in Chelsea, celebrating
its first anniversary at the
Trust. If you would like to
attend, please contact the
Foundation Trust Office.
In the spotlight
JOHN
PRESTON
environment in which the
Trust operates and ensuring
we communicate and engage
sufficiently with Members.
Tell us a bit about yourself
I’m married with two sons, who
are both at university. I live near
Battersea Park and work in
insurance in the City.
How has The Royal Marsden
developed from being a
Foundation Trust during
your time a Governor?
Excellence and innovation are
still the focus. The Board has set
a clear strategy and is delivering
to a high standard. The Council
of Governors has become an
increasingly effective part of the
overall governance of the Trust.
Why did you decide to stand
for election to be a Governor?
When he was 13, my younger
son had a malignant brain
tumour. The care and advice we
received from staff at The Royal
Marsden was excellent. I wanted
to give something back.
What are your aims as a
Governor over the next year?
To become more familiar with
the Trust’s operations and to
increase engagement with
carers who can offer many
insights to improve standards
and the patient experience.
What does a Governor do and
what challenges do you face?
We represent the interests of
Members and hold the Board
to account for the Trust’s
performance. The challenge is
in understanding the complex
Why should people
become Members?
You will have a greater say
in how The Royal Marsden’s
services are run. It’s easy and
free to join, and the level of
involvement is up to you.
The Carer Governor tells us
why he stood for election
and about his ambitions
to persuade more people
to become Members
Become a Governor
In April, Patient Members who
live in South West London or
East Elmbridge & Mid-Surrey
will be invited to nominate
themselves to become a Royal
Marsden Governor. The election
will be for two seats on the
Council of Governors for
the South West London
constituency and one for the
East Elmbridge & Mid-Surrey
area. If you are interested,
please contact the Foundation
Trust Office for further details.
Details of the election of the
Public Governor representing
Elsewhere in England Members
will be included in the next
edition of RM.
Your Council of Governors
Governors continue to be
involved in key developments
at the Trust. At the last Council
of Governors meeting, they
gave their views in discussion
with the Chairman and the
Directors about plans for the
Integrated Cancer System (see
page 4) and the Trust’s Quality
Account. They also formally
approved the reappointment of
two non-executive directors.
Foundation news
Your Governors
at a glance
Having a say
MEMBERS’ EVENTS REVIEW
he Trust held a special
Members’ event in
November at Chelsea
to give people the chance to
have an input into our Quality
Account process.
Members learned about
action being taken on some of
the priorities for improvements
that were identified by Members
at an event last March.
Members also had the
chance to meet Governors and
staff, and tour the Ambulatory
Care Centre, which includes
a purpose-built medical day
unit, clinical assessment unit
and pharmacy unit.
Hosted by Liz Bishop, Interim
Chief Nurse, the event included
presentations about the
development of the Information
Prescription Service, which is
being put in place to ensure
the Trust improves information
provision at every stage of the
patient’s journey. Members were
also updated on improvements
to Patient Transport Services
and the planned implementation
of a two-stop process to improve
chemotherapy waiting times.
Members gave feedback to
staff and Governors on how the
Information Prescription Service
could be rolled out and on
the standards in Patient
Transport Services that should
be monitored to ensure the
services meet patients’ needs.
A further event took place
in February at our Sutton site,
with guest speakers including
Dr Clare Shaw, Consultant
Dietitian, who discussed diet
and nutrition during different
stages of a patient’s pathway.
Members who want to be
more involved in such activities
(Level Two Members) receive
personal invites, so if you
would like to be included in
this group, then please contact
the Foundation Trust Office.
Dates for your diary
Members’ event
Due to take place this summer in Chelsea. Contact the Foundation Trust Office for more information.
Council of Governors meetings
29 February 2012, 11am–1pm, Board Room, Fulham Road, Chelsea
15 May 2012, 11am–1pm, Cripps Lecture Theatre, Sutton
Patient Governors
XPaediatric and Adolescent
Stacey Munns
XSouth West London
Anita Gray, Fiona Stewart,
Raelene Salter, Edward Crocker
XEast Elmbridge & Mid-Surrey
Dr James Laxton, Chris Pelley
XGreater London
Dr Geoff Harding,
Hilary Bateson
XElsewhere in England
Sally Mason, Vikki Orvice
Carer Governors
Lesley-Ann Gooden,
John Preston, John Howard
Public Governors
XKensington & Chelsea
Dr Carol Joseph
XSutton & Merton
Tony Hazeldine
XElsewhere in England
To be confirmed
Staff Governors
XDoctor Professor Ian Smith
XNurse Lorraine Hyde
XOther clinical professional
Nina Kite
XNon-clinical Kim Andrews
Nominated Governors
XInstitute of Cancer Research
Cathy Scivier
XPrimary Care Referrer
Dr Chris Elliott
XSouth West London Cancer
Network Alison Hill
XWest London Cancer
Network vacant
XLondon Borough of
Kensington & Chelsea
Councillor Robert Freeman
XSutton & Merton PCT
Dr Martyn Wake
XCroydon PCT vacant
XNHS Kensington & Chelsea
Mable Wu
XSurrey PCT Michael Munt
XCancer Research UK
(charity) Kate Law
XUniversity Partner vacant
If you have any questions
or would like to become
a Member, call the Foundation
Trust Office on 0800 587 7673
or email foundation.trust@
rmh.nhs.uk
RM MAGAZINE 29
PUZZLES & PRIZES
Test your wits
Win!
Complete our crossword and you could win a £50 John Lewis voucher
SUDOKU
2 1
8
6 4 2
2 1 9 8
9
7
4
4 1 2
9
6
1
8
1
3 2
9
5
2
7
3
5 7
6
4
Star letter
Dear RM, I want to express my gratitude for the
amazing care I receive at the Marsden. I was diagnosed
with breast cancer four years ago and had excellent
treatment from the late Mr Querci and Oncologist
Dr Mark Allan. I am now under Ms Rusby’s team.
One Sunday, I found another lump. The next day,
I phoned Ms Rusby’s secretary to ask if I could bypass
visiting my GP. She offered me a next-day appointment
in Ms Rusby’s clinic. I was seen spot on at 3pm by
D6HQLRU+RXVH2I¿FHUDQGD5HJLVWUDUDQGE\SP
I’d not only had an ultrasound but also the results.
The service you offer your breast cancer patients is
PHENOMENAL and I cannot thank you all enough.
God bless, Claire Lacey
3
4
7
5
6
Across
1 Group of musicians (9)
7 Eye socket (5)
8 Jockey (5)
9 Epoch (3)
10 Part of the foot (6)
6KUHZG
15 Cacophony (3)
18 Thigh bone (5)
20 Ice hut (5)
21 Court game (9)
8
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11
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19
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20
21
Fill in your details below when sending in your crossword
competition entry. See right for details of our address.
NAME
ADDRESS
PRIZE CROSSWORD
Down
:RRGZLQGLQVWUXPHQW
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&RQVXPHV
'HVSRW
5 Assistance (3)
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11 One of three (7)
12 Perplex (6)
13 Gaped (6)
)OLJKWOHVVELUG
0HWDOPRQH\
19 Disorderly crowd (3)
CONTACT DETAILS
Congratulations to Ian Bradbury, who
won the winter issue’s crossword prize.
30 RM MAGAZINE
The lucky winner
of our prize
crossword will
receive £50 of John
Lewis vouchers.
We also welcome
your thoughts on
RM magazine and
love to hear about
your experiences at
the hospital. Star
Letters win a £50
John Lewis voucher.
Send your crossword or
letter with your name and
contact details to RM, Press
Office, The Royal Marsden,
Fulham Road, Chelsea,
London SW3 6JJ. The
closing date for entry is
Tuesday 8 May 2012.
See below for prize
draw rules.
PRIZE DRAWS & STAR LETTER TERMS &
CONDITIONS: 1. The Prize Draws and Star Letter
are open to all readers of RM except employees
RIWKH3UHVV2IÀFHDW7KH5R\DO0DUVGHQDQG
Sunday, who produce RM magazine. 2. The closing
date for receipt of all entries is Tuesday 8 May
2012. Only one entry per person per draw.
3. Responsibility cannot be accepted for entries
which are incomplete, illegible or not received.
Proof of posting is not proof of receipt. No cash
alternative is available and prizes are not
transferable. Value of prizes is correct at time of
JRLQJWRSUHVV:LQQHUVZLOOEHQRWLÀHGE\SRVW
within 14 days of closing date. 5. The Promoter’s
decision on any aspect of the promotions is
ÀQDODQGELQGLQJDQGQRFRUUHVSRQGHQFHZLOO
be entered into. 6. The Promoter reserves the
right to substitute a prize of equal or greater
value should circumstances make this necessary.
7. Entry implies acceptance of rules. 8. The
winner of the Star Letter prize of £50 of John
Lewis vouchers is the sender of the best letter
selected by RM magazine. 9. The winner of the
crossword prize of £50 of John Lewis vouchers
ZLOOEHWKHÀUVWFRUUHFWHQWU\GUDZQRXWRIWKH
bag. 10. The Promoter is The Royal Marsden
Hospital, 203 Fulham Road, London SW3 6JJ.
IN THE NEXT ISSUE
RM brings you the latest hospital updates, research news, inspiring
stories and exclusive interviews. The summer 2012 issue is coming soon…
New scanning machines
for Sutton and Chelsea
Photos from our second
Marsden March
Update on the new Centre
for Molecular Pathology
FOR THE ROYAL MARSDEN
Rachael Reeve – Director of Marketing and Communications
Elaine Parr – PR and Communications Manager Belinda Payne – Senior Press Officer
Catherine O’Mara – Senior Press Officer Marie-Thérèse Wright – Press Officer
FOR SUNDAY
Lucy Ryan – Editor Marc Grainger – Sub Editor Catherine Hopkinson – Art Director
Lindsay Williams – Account Director Matt Beaven – Creative Director
Toby Smeeton – Managing Director
RM magazine is published by The Royal Marsden in partnership with Sunday: sundaypublishing.com
© The Royal Marsden 2012. All rights reserved. Reproduction in whole or part is prohibited without prior permission of the Editor. The Royal Marsden
and Sunday accept no responsibility for the views expressed by contributors to the magazine. Repro by F1 Colour. Printed by Pureprint.
Up for a
challenge?
Are you looking for
excitement, new
experiences and a real sense
of achievement?
Have you considered a challenge event for
The Royal Marsden Cancer Charity?
2XU&KDOOHQJH(YHQWVWHDPFDQRƬHU\RXD
wide range of adventures from parachute
jumps to marathons, walks along Hadrian’s
wall, to cycling Vietnam.
The list is (almost) endless.
Email [email protected] or visit
www.royalmarsden.org/challenges
Registered Charity No. 1095197