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St Vincent’s
Healthcare Group
Cancer Annual
Report 2014
Contents
Overview by Chairman of Cancer Committee
1
Breast Cancer
2
Colorectal Cancer
9
Haematology12
Hepatocellular Carcinoma
17
Gynaecological Cancer
19
Pancreatic, Hepatobiliary and Upper GI Cancers
21
Lung Cancer
24
Neuroendocrine Tumours (NET) Service
26
Head & Neck Cancer
28
Radiology32
Sarcoma37
Skin Cancer
42
Urological Cancers
43
Medical Oncology
48
Health and Social Care Professionals
51
Daffodil Centre
57
Publications 2014
67
Overview by
Chairman of the
Cancer Committee
Prof P Ronan O’Connell
It is my pleasure to introduce the St Vincent’s Healthcare Group (SVHG) Cancer Report
2014. SVHG comprises St Vincent’s University Hospital (SVUH), St Vincent’s Private
Hospital (SVPH) and St Michael’s Hospital (SMH). SVUH is one of the eight cancer centres
under the HSE National Cancer Control Programme (NCCP). The range of services
encompasses diagnosis, staging and all aspects of cancer treatment including radiation
oncology.
SVHG has a long tradition of treating patients with cancer. The remit of the Cancer
Committee is to promote patient care and safety through continuous quality
improvement and clinical risk management in a multidisciplinary culture, ensuring
compliance with National and International standards of best practice.
A priority of the Cancer Committee is to produce an Annual Report on cancer related
activity across the campus. The present report describes staffing, patient volume,
complexity of care, clinical outcomes achieved, research and publications for 2014.
Significant progress in data management has been made with the development of a
common management system with central data entry using the Excelicare™ system.
This will support development of a clinical cancer registry and drive key performance
indicators.
A major addition to the services provided on the campus was the opening of an
Irish Cancer Society Daffodil Centre in the atrium of SVUH. The centre has been an
unprecedented success and dealt with 13,719 enquiries from patients and relatives
during 2014.
Priorities for the Cancer Committee in 2015 include development of treatment
algorithms for common cancers in support of multidisciplinary team meetings, common
protocols for tissue bio-banking, and increasing awareness of and recruitment to clinical
trials in cancer treatment.
I would like to thank my colleagues for their support in the publication of this report
which I feel will be instrumental in driving quality improvement and development of
cancer services across the campus.
Page 1
Breast Cancer
2014 has proven to be another very busy year for the Breast Service in St Vincent’s University Hospital. Once
again, a very large number of new patients were referred to the service. The vast majority of new patients are
triaged into the appropriate clinic, evaluated clinically with imaging, and are discharged.
Significant resources are devoted to evaluation of patients with benign breast disease. There continues to be
a very large demand for this service and while there are high volumes of new referrals, there has not been a
corresponding increase in the number of new cancers diagnosed.
Patients diagnosed with breast cancer have their clinical examination, imaging and tissue sampling
performed usually in a single visit. The great majority of patients diagnosed with cancer present with
symptoms worrying for breast cancer and are triaged into the urgent subset of patients, in accordance
with NCCP Guidelines and are seen within two weeks. Patients that have lesions that are categorised as
indeterminate, probably malignant or malignant, have tissue sampling performed and all of these patients
are discussed at a multidisciplinary meeting.
The multidisciplinary meetings are attended by a large range of sub-specialists from various disciplines
including Surgery, Radiology, Pathology, Medical Oncology, Radiation Oncology and Reconstructive Surgery.
The multidisciplinary meetings are also attended by Breast Care Nurses, Junior Doctors, Radiographers,
Medical Scientists, Medical Students and other members of the team including Data Management and
Administration.
The multidisciplinary meeting is an essential component of the service. All patients who have tissue
sampling are discussed at the meeting within one week. Patients who have concordant benign results, i.e.
benign pathology, radiology and clinical examination, are discharged. Patients with indeterminate results
or discordant results are either re-biopsied or proceed to surgery. Patients with a definitive diagnosis of
cancer have their further management decided by the multidisciplinary team. The recommendation of
the multidisciplinary team is documented but the ultimate decision with regard to the management of the
patient is the result of a meeting between the patient and the treating clinician.
Over the last few years, there has been an increase in patients referred for neoadjuvant chemotherapy.
Page 2
St Vincent’s Healthcare Group Cancer Annual Report 2014
Patients referred for neoadjuvant chemotherapy have their management discussed at the time of diagnosis
and subsequently following chemotherapy, at which stage the type of surgical management is decided.
The National Clinical Guidelines for Breast Cancer published by the NCCP in 2014 have resulted in changes
to surgical practice. Smaller margins are now accepted and in patients with micro-metastatic disease in
the axillary lymph nodes, axillary clearance is not always needed and is managed in accordance with the
guidelines. Each patient is discussed fully and the management is tailored to the patient’s needs.
In 2014, an increased number of patients who had surgery for breast cancer were admitted on the morning
of surgery, had their surgical procedure and were discharged on the same day. As in previous years, there
has been an emphasis on recruiting patients to clinical trials and this is fostered and encouraged by the
clinicians.
Also in 2014, it was decided that patients with family history should be identified and have their risk
assessment at the general breast clinic. Patients in the high risk category are then separately referred to
a specialist family history clinic that has been established specifically for the management of high risk
family history patients, who require specific counselling, genetic testing and occasionally prophylactic
management whether surgical or medical.
The Merrion BreastCheck Unit again had a very busy year. The patients diagnosed with breast cancer
through screening in the Merrion Unit and on mobiles attached to the Merrion Unit, had their surgical
management in St Vincent’s Hospital. All patients referred to St Vincent’s Private Hospital for management
of either benign or malignant disease are discussed at the multidisciplinary meeting in St Vincent’s
University Hospital.
The Breast Care Nurses continue to provide an essential role in the care and counselling of patients
diagnosed with breast cancer. The Breast Care Nurses are responsible for the psychological support but
also for the logistical organisation of both surgical and medical oncology interventions. They play a central
role in patient education and are instrumental in explaining surgical and medical oncology interventions to
the patients and their families. The Breast Care Nurses continue to look after the patients post–operatively
and provide support as required.
Symptomatic Breast Cancer Outpatient Episodes 2014
Outpatient Episodes 2014
SVUH
SVPH
SVHG Total
13
3
16
1
1
2
New Patients
5,288
1,378
6,666
Review Patients
3,991
2,943
6,934
Total Number of Patients Seen
9,279
4,321
13,600
No of Outpatient clinics per week
Designated Cancer Outpatient Clinics per week
New patient attendance in SVUH has increased from 5,014 patients in 2012 to 5,192 in 2013 to 5,288 in
2014. This represents a percentage increase of 5.5% from 2012 to 2014.
Return patient attendance has decreased from 4,730 in 2012 to 4,153 in 2013 to 3,991 in 2014. This
represents a percentage decrease of 15.5% from 2012 to 2014.
Page 3
Breast Cancer Data
There is a very effective Data Management team which collates and provides valuable analysis on the
Breast Cancer patients assessed and treated within St Vincent’s Hospital Group.
Breast Care Key Performance Indicator Submissions to NCCP in 2014
0
100
200
300
400
500
January
DNA (Did not attend) SVUH
2012 to 2014
Percentage of Patients that did not attend
appointments 2014/2013/2012
February
2014
March
New DNA
Return DNA
7%
11%
2013
April
New DNA
Return DNA
7%
12%
2012
May
June
New DNA
Return DNA
7%
12%
July
August
September
October
November
December
0
100
200
300
400
500
2014 (New)
2013 (New)
2012 (New)
2014 (Return)
2013 (Return)
2012 (Return)
Page 4
Triage Breakdown SVUH 2014
Assessment Clinic Outcome for
New Patients SVUH 2014
0.58%
33.94%
10.80%
Discharge
18.59%
66%
Early
Breast Clinic
Routine
Discharge if R1/R2
Urgent
Proceed to Surgery
6.38%
Results Clinic
63.65%
0.06%
Symptomatic Breast Centre and Breast Check Cancer Diagnosis 2014
SVUH and SVPH
BreastCheck
Total
New Patients diagnosed with Cancer
355
245
600
Total SBC Cancer Diagnosis
401
245
646
Of the 355 new Primary cancers diagnosed in SVUH/SVPH, 71 patients (20%) tested positive for
node positive breast cancer by FNA or core biopsy of axillary lymph node.
SVUH/SVPH Primary Breast Cancer Diagnosis Age Breakdown 2014
160
159
140
120
100
98
80
92
60
40
20
0
6
Younger than 35 (1.7%)
35 - 49 (27.6%)
50 - 65 (25.9%)
Greater than 65 (44.8%)
Page 5
Breast Cancer Interventions 2014
Radiological Intervention
SVUH and SVPH
Core biopsy or FNA
1,215
SVUH/SVPH Primary Breast Cancer Patients 2014 Investigations
CT CAP/TAP
Bone Scan
MRI Breasts
Dexa Scan
210
200
112
70
Number of Patients
Therapeutic Procedures 2014 Breakdown SVHG (Total 730)
Number of patients
350
313
300
250
200
150
100
70
0
Bx
N
LE
a
S
nd
W
om
t
ec
st
Ma
y
ste
Ma
ya
m
o
ct
Bx
x
N
S
nd
st
Ma
A
nd
ya
om
t
ec
61
54
50
50
Cl
Bx
x
N
S
nt
fro
Up
LE
W
a
A
nd
Cl
66
53
36
21
LE
gi
W
xc
-E
Re
ns
r
Ma
Ax
4
CL
xc
xc
-E
Re
S
nd
sa
gin
r
Ma
x
NB
gi
r
Ma
-E
Re
2
ns
SVUH/SVPH Therapeutic Surgeries- Pathology Staging 2014
T Stage
N Stage
T0
4.4%
N0
56%
Tis
12.2%
N1
32%
T1
38.1%
N2
8%
T2
40.6%
N3
4%
T3
4.4%
T4
0.3%
Prophylactic Mastectomies 2014 SVUH and SVPH
There were a total of 18 patients who underwent prophylactic mastectomies in 2014.
Diagnostic Surgery- Excision Biopsies 2014 SVUH and SVPH
There were a total of 119 patients who underwent an excisional biopsy of breast in 2014.
Page 6
Primary Breast Cancer- First Treatment 2014 (SVUH and SVPH)
160
140
145
Number
of patients
120
100
80
70
67
60
40
40
20
36
25
0
en
tm
ea
Tr
t1
en
tm
ea
Tr
t2
en
tm
ea
Tr
t3
en
tm
ea
Tr
t4
en
tm
ea
Tr
t5
en
tm
ea
Tr
1
6
6
t
en
tm
ea
Tr
1
t7
ea
Tr
t8
en
tm
Chart Legend
Treatment 1
Wide Local Excision of Breast Lesion (145)
Treatment 2
Mastectomy (67)
Treatment 3
Neo-Adjuvant Chemotherapy (70)
Treatment 4
Hormone Therapy- No Surgery/Chemotherapy/Radiotherapy (40)
Treatment 5
Treatment given in 2015 (25)
Treatment 6
Transferred to another hospital for treatment (6)
Treatment 7
Re-Excision of Margins(Following Diagnostic Surgery Diagnosis) - No
Mastectomy or WLE (1)
Treatment 8
RIP after diagnosis prior to any treatment (1)
Page 7
Breast Care Key Performance Indicator Submissions to NCCP in 2014
Month
Dates for submission
Report Details
January
January 14th
SBD Dec 2013
OPD Dec 2013
February
February 14th
SBD Jan 2014
OPD Jan 2014
March
March 14th
SBD Feb 2014
OPD Feb 2014
March 31st
Quarterly KPI Report to cover time period:
Q4 Oct – Dec 2013
April
April 14th
SBD Mar 2014
OPD Mar 2014
April 30th
Annual KPI Report to cover time period:
Jan – Dec 2013
May
May 14th
SBD Apr 2014
OPD Apr 2014
June
June 14th
SBD May 2014
OPD May 2014
June 30th
Q1 Jan - Mar 2014
July
July 14th
SBD Jun 2014
OPD Jun 2014
August
August 14th
SBD Jul 2014
OPD Jul 2014
September
September 14th
SBD Aug 2014
OPD Aug 2014
September 30th
Q2 Apr - Jun 2014
October
October 14th
SBD Sep 2014
OPD Sep 2014
November
November 14th
SBD Oct 2014
OPD Oct 2014
December
December 14th
SBD Nov 2014
OPD Nov 2014
December 31st
Q3 Jul - Sep 2014
-
New patient attendance increased by 1.8% (5,192 patients to 5,288)
-
Return patient attendance decreased by 3.9% (4,153 patients to 3,991)
-
New patient DNA remained unchanged at 7%
-
Return patient DNA decreased from 12% to 11%
-
Almost 64% of New patients discharged on first visit
-
1.3% increase in number of core biopsies/ FNA procedures (1,199 to 1,215)
-
SBC diagnosis SVHG decreased by 3% (666 patients to 646)
-
Number of therapeutic surgeries has reduced by 2% (747 to 730)
Page 8
Colorectal Cancer
Introduction
Colorectal cancer is a major clinical interest for the Unit. In 2014, 347 new patients with colorectal
cancer were referred.
300
276
2013
241
250
200
2014
150
100
55 49
50
0
8
Primary
8
4
Synchronous 12
4
Metachronous
Metastatic
10
Recurrence
131 patients of the 347 were diagnosed with a primary / synchronous / metachronous / recurrent
tumour and metastasis.
Tumour Type
with Mets
Total
199
77
276
Synchronous
6
2
8 Metachronous
3
1
4
Recurrence
8
2
10
49
49
131
347
Primary
Metastatic
Overall Total
216
2013
Anus
Colon
Local Recurrence
Metastatic
Rectum
Grand Total
SVPH
78
7
22
52
159
SVUH
5
81
5
33
47
171
Total
5
159
12
55
99
330
2014
Anus
Colon
Local Recurrence
Metastatic
Rectum
Grand Total
SVPH
4
87
4
26
59
180
SVUH
7
93
6
23
38
167
Total
11
180
10
49
97
347
Page 9
R E C TAL
Rectal
40
35
37
30
32
28
25
20
15
10
5
0
Rectum (lower)
Rectum (mid)
Rectum (upper)
Colon
C OL ON
Ascending colon
37
Caecum
47
Hepatic flexure
3
Transverse colon
13
Splenic flexure
6
Descending colon
8
Sigmoid
50
Rectosigmoid junction
16
Total
180
Rectal Cancer Procedure
Anterior resection
APER abdominoperineal resection
EUA
100
80
87
66
60
40
20
0
Right
13
14
Transverse
colon
Descending
Sigmoid
colon
SVPH
SVUH
TOTAL
25
23
48
5
8
13
25
7
32
2
2
Hartmann’s procedure
Pelvic clearance
2
4
6
Polypectomy
2
1
3
Trans anal
12
4
16
Grand Total
71
49
120
Page 10
Colon Cancer Procedure
SVPH
SVUH
TOTAL
11
2
9
1
2
2
6
8
34
12
2
1
20
3
2
4
11
13
73
14
2
1
1
144
Rectosigmoid resection
Extended right hemicolectomy
Hartmann’s procedure
Laparotomy only
Left hemicolectomy
Polypectomy
Right hemicolectomy
Sigmoid colectomy
Small Bowel Resection
Sub total colectomy
Transverse colectomy
Grand Total
2
5
5
39
2
1
67
77
2014 Rectal Cancer Surgery Types
40
35
SVPH
30
SVUH
25
20
15
10
5
0
Laparoscopic
Laparoscopic
assisted
Laparoscopic
converted
Open
Other
Procedures
2014 Colon Cancer Surgery Types
50
SVPH
40
SVUH
30
20
10
0
Laparoscopic
Laparoscopic
assisted
Laparoscopic
converted
Open
Other
Procedures
The multidisciplinary approach to colorectal cancer is reflected in a high percentage of patients receiving
neoadjuvant therapy for rectal cancer and post operative adjuvant therapy in colon cancer.
In collaboration with other members of the Centre for Colorectal Disease, the Unit has a major research interest
in the molecular biology of colorectal cancer and in particular the response of rectal cancer to neoadjuvant
chemoradiotherapy and prediction of the metastatic potential of node negative disease.
Page 11
Haematology
Introduction
The Haematology Department in St Vincent’s University Hospital provides care for patients with general
and malignant haematological disorders including leukaemia, myeloma and lymphoma, as well as patients
undergoing autologous stem cell harvesting and transplantation. The service is provided in a 20 bedded
dedicated combined Haematology/Oncology unit in St Anne’s Ward. Over the past number of years there
has been an increasing move to treat patients in the ambulatory setting and avoid inpatient admissions as
much as possible.
The Haematology service is provided by Dr G Connaghan, Dr K Murphy, Dr K Fadalla and Dr D McCarthy, with
a team of Specialist Registrars, Registrars, Senior House Officers and Clinical Nurse Specialists.
The Consultants provide specialist service for leukaemias, myeloprolifertive and multiple myeloma
patients in designated specialist clinics. The Lymphoma service is delivered by a combined
haematology/oncology team. Access is therefore provided to an integrated treatment pathway for
all haematology patients including standard chemotherapy/biological therapy and transplantation.
Page 12
In 2014, 355 patients had a malignant haematological disorder compared with 306 such patients in 2013.
HAEMATOLOGIC MALIGNANCY 2014
2013
2014
Multiple Myeloma (MM)
57
64
Myelo Dysplastic Syndrome (MDS)
21
25
Acute Lymphocytic Leukaemia (ALL)
11
9
Acute Myeloid Leukaemia (AML)
14
31
Myeloproliferative Neoplasm (MPN)
18
21
113
120
Hodgkins Lymphoma (HL)
19
31
Chronic Lymphocytic Leukaemia (CLL)
53
37
0
17
306
355
Non Hodgkins Lymphoma (NHL)
TOTAL
120
113
120
2013
100
80
2014
60
40
20
0
57
53
37
31
11
9
64
31
21
19
14
25
18
21
17
0
ALL
AML
CLL
HL
MM
MDS
MPN
NHL
OTHER
Patients diagnosed with a malignant haematological disorder in 2014 can be categorised as new diagnoses,
relapses and patients who receive ongoing care. Details relating to this patient group are as follows:
HAEMATOLOGIC MALIGNANCY
NEW
RELAPSE
ONGOING
24
0
40
13
0
12
3
0
6
23
2
6
12
0
9
83
21
16
23
6
2
14
2
21
8
1
8
203
32
120
Other
TOTAL
Page 13
120
Ongoing
16
Relapse
100
21
New
80
60
40
40
6
2
20
0
21
2
6
12
2
6
3
23
ALL
AML
9
8
1
14
23
24
13
12
83
CLL
HL
MM
MDS
MPN
NHL
8
Other
HAEMATOLOGY MULTIDISCIPLINARY TEAM
Multidisciplinary working is integral to haematology and includes several weekly multidisciplinary team (MDT)
meetings. These include a Bone Marrow, Lymphoma and Haematology MDT, at which all new, relapsed and ongoing cases are discussed to formulate a management plan.
Page 14
In 2014, 355 patients had a
malignant haematological
disorder. Details relating to
the 355 of the patients with a
haematological malignancy is
as per the chart opposite:
HAEMATOLOGIC MALIGNANCY 2014
OCCURRENCES
9
31
Acute Promyelocytic Leukaemia
1
Angioimmunoblastic Lymphoma
1
Atypical B-Cell Lymphoproliferation
1
Burkitts Lymphoma
2
37
Diffuse Large B-Cell Lymphoma (DLBCL)
54
Follicular Lymphoma
9
Follicular Non Hodgkins Lymphoma
14
Hairy Cell Leukaemia
4
High Grade B-Cell Lymphoma
1
31
Low Grade B-Cell Lymphoma
2
Lymphoplasmacytic Lymphoma
1
MALT Lymphoma
5
Mantle Cell Lymphoma
9
Mastocytosis
1
64
25
Myelofibrosis
2
21
18
Plasma Cell Leukaemia
2
Plasma Cell Myeloma
3
Plasmablastic Lymphoma
1
Seminoma
1
Small Lymphocytic Lymphoma
1
Splenic Marginal Zone Lymphoma
1
Waldenstroms
3
TOTAL
355
80
70
60
50
40
30
20
10
Waldenstroms
Splenic Marginal Zone Lymphoma
Seminoma
Small Lymphocytic Lymphoma
Plasma Cell Myeloma
Plasmablastic Lymphoma
NHL
Plasma Cell Leukaemia
Myelofibrosis
MM
MPN
MDS
Mastocytosis
MALT Lymphoma
Mantle Cell Lymphoma
Lymphoplasmacytic Lymphoma
HL
Low Grade B-Cell Lymphoma
Hairy Cell Leukaemia
High Grade B-Cell Lymphoma
Follicular Lymphoma
Follicular Non Hodgkins Lymphoma
CLL
DLBCL
Burkitts Lymphoma
Angioimmunoblastic Lymphoma
Atypical B-Cell Lymphoproliferation
ALL
AML
Acute Promyelocytic Leukaemia
0
Page 15
Stem Cell Transplant Programme
The Haematology service is responsible for the Tissue Establishment which runs the Stem Cell Transplant
Programme within St Vincent’s University Hospital.
The Tissue Establishment is authorised to collect blood forming stem cells from patients with blood cancers,
freeze them, store them and subsequently use them for treating patients with diseases such as myeloma and
lymphoma. This service takes referrals from both the Haematology and Oncology teams. The whole procedure is
referred to as autologous peripheral blood stem cell transplantation.
23 patients were harvested which resulted in 35 stem cell processing events being performed. During 2014
twenty five patients were successfully transplanted. The Tissue Establishment was inspected by the Health
Products Regulatory Authority in May 2014 and the Department was successful in maintaining its licence.
SVPH
24%
The Haematology MDT in St Vincent’s University Hospital
discusses patients of both St Vincent’s University Hospital and
St Vincent’s Private Hospital. Of the 355 patients discussed in
2014, 86 were patients of St Vincent’s Private Hospital, which
accounts for 24% of patient discussion.
SVUH
76%
HAEMATOLOGY GENDER DISTRIBUTION
SVPH
24%
Gender Distribution
FEMALE
47%
355 patients were seen by the Haematology service in 2014.
The Haematology patient gender distribution shows that 187
of the patients were male compared with 206 female patients.
SVUH
76%
Page 16
MALE
53%
Hepatocellular
Carcinoma
Introduction
Hepatocellular Carcinoma (HCC) is a primary cancer of the liver. It invariably occurs in the setting of liver cirrhosis.
The National Liver Transplant service is based in St Vincent’s University Hospital, led by three Hepatologists:
Professor Aiden McCormick, Dr Diarmaid Houlihan and Dr Masood Iqbal; and three transplant surgeons: Mr Emir
Hoti, Mr Justin Geoghegan and Mr Donal Maguire. As a result of this national designation, a large portion of the
country’s patients at risk of developing HCC are reviewed in SVUH. New diagnoses of HCC are also referred to
SVUH for advice and management. The treatment of HCC is complex, utilising multiple treatment modalities.
The multidisciplinary team in SVUH is uniquely positioned to provide individualised therapy for these patients.
A dedicated multidisciplinary HCC service was established in December 2013. This incorporates a HCC clinic
which is run weekly, staffed by Dr Houlihan, the HCC Clinical Nurse Specialist Ms Michele Bourke, with the
support of a surgeon and palliative care services. To ensure the effective running of this service, a HCC working
group convenes monthly. It is attended by Dr Houlihan, Ms Bourke, Dr Ronan Ryan (Consultant Interventional
Radiologist), Mr Mark Jeffrey (ADON), Ms Mary Linnane (CNM2 Radiology) and Ms Maire Ní Chinnéide (CNM2 St
Brigid’s Ward).
Upon referral to the liver service, the patients’ images are reviewed at the weekly radiology MDM by a Consultant
Radiologist, Consultant Interventional Radiologist, Consultant Hepatologist and a Consultant Surgeon. If a
diagnosis of HCC is made, the best course of treatment is discussed and decided upon.
In 2014, a database was prospectively maintained for HCC for the first time. It is difficult therefore to compare
2014 activity levels to those of previous years.
Page 17
2014 Hepatocellular Carcinoma Activity Levels
No of MDMs
49
No of MDM HCC Discussions
379
No of Referrals to service
156
No of New HCC Diagnoses
76
Treatment for HCC is guided by the Barcelona Clinic Liver Cancer (BCLC) staging system. The options range
from curative treatments to palliative and supportive therapies. These include liver transplantation, liver
resection, thermal ablation (radiofrequency ablation, RFA and microwave ablation, MWA), transarterial
chemoembolisation (TACE) and Sorafenib, an oral chemotherapeutic agent. Some patients may be eligible
for a combination of these treatments depending on their tumour burden and performance status. Many
will require repeat treatments with thermal ablation and TACE. This requires a lot of coordination between
the HCC CNS and the Interventional Radiology department. Those patients referred for liver transplant and
resection are cared for in conjunction with the HCC service. Patients with end-stage HCC and liver disease
are cared for in conjunction with Dr Eoin Tierney and the Palliative Care Team.
2014 Hepatocellular Carcinoma Treatments
Treatment
No
Liver Transplant Patients listed for transplant
15
Patients transplanted
10
Liver Resection
8
Thermal Ablation (RFA and MWA) Scheduled
8
Done
4
Transarterial Chemoembolisation Scheduled
112
Done
75
Sorafenib (Nexavar)
16
The work load of the Interventional Radiology department is rising yearly due to the increased burden of
HCC nationally, particularly for patients requiring TACE.
Treatment
2011
2012
2013
2014
Thermal Ablation
7
8
7
4
TACE
40
55
61
75
Research
There is an international trial currently underway in the UK, TACE-2. SVUH is now registered as a trial site
and is currently enrolling patients for this trial.
Page 18
Gynaecological Cancer
Introduction
General gynaecology services are provided mainly on the St Vincent’s campus and the National Maternity
Hospital with outpatient clinics provided in St Michael’s and St Columcille’s hospitals. Gynaecological cancer
services have evolved in recent years with the establishment of web based regional multidisciplinary team
meetings including representation of pathology and radiology as well as surgery, radiation oncology and
medical oncology at which all cases are discussed.
Diagnostic Services
The National Maternity Hospital has the largest colposcopy service in the country for the diagnosis and
management of women with abnormal cervical cytology. In addition the gynaecological departments of St
Vincent’s and the National Maternity Hospital offer rapid access for the management of women with abnormal
uterine bleeding. St Vincent’s has a very busy regional emergency service through which many of the women
with abdomino-pelvic masses present. Specialist pathology and radiology services are available on site.
Treatment services
There has been a shift of much of the major surgery to the St Vincent’s campus with use of the capacity available
at the National Maternity Hospital for less invasive surgery. Radiotherapy is provided mainly at St Luke’s Hospital
as well as St Vincent’s. Medical oncology services are provided at St Vincent’s.
A regional cancer nurse co-ordinator manages the flow of women between locations as well as collecting the
data and co-ordinating the MDT meetings. These take place every second Wednesday between St Vincent’s and
the National Maternity Hospital using the web based solution GotoMeeting. Proceedings of the meetings and
records of attendance are maintained.
SPECIALIST NUSING
Helen Craig
RADIOLOGY
Risteard O’Laoide
Suzanne Shine
SURGERY
Grainne Flannelly
Peter Lenehan
Michael Foley
Donal O’Brien
RADIATION ONCOLOGY
Osama Salib
MEDICAL ONCOLOGY
David Fennelly
PATHOLOGY
Eoghan Mooney
David Gibbons
Paul Downey
2014 proved to be another busy year for the service with 175 new cases of gynaecological cancer diagnosed. The
anatomical site of the cancer according to the hospital of diagnosis is included in the table below.
Page 19
New Gynae Cancers 2014
NMH
SVUH
SVPH
TOTAL
Cervix
38
2
4
44
Endometrium
26
10
26
62
Ovary
15
17
25
57
Vulva
4
2
6
12
Total
83
31
61
175
Cervical cancer was diagnosed in 44 women, 84% of whom were aged less than 50 years. Microinvasive
cancer (Stage 1a) was the diagnosis in 59% with a further 22% being stage 1b. Fertility sparing conisation using
cone biopsy or LLETZ was performed in 22 women of whom three had laparoscopic dissection of the pelvic
lymph nodes. Eight women underwent radical hysterectomy of which three were performed laparoscopically.
One woman had a simple hysterectomy for early stage disease. A simple hysterectomy for menorrhagia was
planned for a further woman but an incidental finding of advanced cervical cancer resulted in a subtotal
hysterectomy only being possible. Primary chemoradiation was performed in nine women with advanced
disease.
Endometrial cancer by contrast presented in an older population with 58 out of 62 new cases occurring in
women over 50 years. The majority of cases were stage one disease with only 10 women documented as stage
two or more. Surgery was the mainstay of treatment with Hysterectomy and bilateral salpingo-oophorectomy
as the commonest procedure with 16 out of 46 documented cases performed by the laparoscopic or vaginal
route. This is a very useful development as many of these women have co-morbidities. Three women had their
primary surgery elsewhere and laparotomy and BSO was performed. In addition 13 women had radiotherapy
and three women underwent chemotherapy.
Ovarian cancer commonly presents late and the experience of 2014 continued this trend. Eighteen of the
57 new cases had stage one disease, 37 were stage three or four. Debulking surgery was performed during
the year in 39 cases. Chemotherapy alone was given to 13 women – some of which were planned for interval
debulking surgery in 2015 – and five women received palliative treatment alone. Two of the women were aged
less than 20, while 48 were aged 50 or more.
Vulval cancer remains an uncommon disease but recent years have confirmed a shift towards younger women
compatible with an increase in HPV related disease. Radical vulvectomy was performed in two cases with wide
local excision being performed in the majority of cases. The advent of sentinel node biopsy has reduced the
need for often troublesome groin node dissections. This was performed in one woman during 2014.
Newly Diagnosed Cancer by age of patient subdivided into a 10 year age range
10 to 19
20 to 29
30 to 39
40 to 49
50 to 59
60 to 69
70 to 79
80 to 89
Total
Cervix
5
18
14
1
3
2
1
44
Endometrium
1
3
14
19
18
7
62
Ovary
2
2
1
7
12
21
9
3
57
Vulva
1
1
3
1
4
1
1
12
Total
2
8
21
27
28
47
30
12
175
Page 20
Pancreatic, Hepatobiliary
and Upper GI Cancers
Introduction
The Hepatopancreaticobiliary (HPB) Surgical Unit at St Vincent’s University Hospital is the largest HPB unit in
Ireland and incorporates the National Surgical Centre for Pancreatic Cancer (NSCPC) and the National Liver
Transplant Program. The unit also provides a comprehensive range of treatments for primary and secondary
liver cancers and biliary tract cancers. The National Neuroendocrine Tumour service is integrated closely with
the HPB service. Treatment planning occurs at multidisciplinary meetings which occur weekly for pancreatic
cancers, and fortnightly for liver and neuroendocrine tumours. A separate liver transplant MDT and radiology
meeting occurs weekly. Numbers of cases seen at all of these MDTs continue to grow steadily. HPB OPD clinics
occur three times each week. Separate clinics for hepatocellular carcinoma patients and neuroendocrine tumour
patients are held weekly.
Frequency
MDT
2013
MDT
2014
2013
Diagnoses
2014
Diagnoses
NCCP Pancreas - 1 per week
51
50
127
155
Hepatobiliary - Dedicated MDT fortnightly
22
20
87
88
Staffing
There are currently five consultant surgeons providing the HPB service - Mr Justin Geoghegan, Mr Donal Maguire,
Mr Emir Hoti, Prof Kevin Conlon and Prof Paul Ridgeway. To assist with the increasing workload, the appointment
of a sixth surgeon is anticipated within the coming months. In terms of NCHD staffing there is one HST Specialist
Registrar and two Liver Surgical Fellows and one surgical registrar. Finally there is one SHO and one to two intern
posts. Two Whole Time Equivalent (WTE) Clinical Nurse Specialists provide vital support to the delivery of the
HPB and NET services – Ms Emer Burton and Ms Anne McGuire. In addition to providing HPB cancer surgery
services the unit also supports the National Liver Transplant Service, as well as proving a national 24/7 service
for liver trauma, biliary injury and other HPB emergencies.
Page 21
An increasing load of patients with hepatocellular carcinoma is dealt with in conjunction with Prof Aiden
McCormick, Dr Diarmuid Houlihan, and Dr Iqbal Masood under the umbrella of the National Liver Transplant
Programme. The Neuroendocrine Tumour Service is led by Prof Dermot O’Toole who also provides on-site endoultrasonography.
Separate funding from the National Liver Transplant Unit and The NSCPC respectively has allowed appointment
of two data managers. This has allowed the unit to develop properly structured clinical databases for HPB and
Transplant activity. Expansion of secretarial and administrative support is in progress to support the progressive
expansion of the unit.
Activity
Since its inception in 2010 the number of referrals to the National Surgical Centre for Pancreatic cancer has
steadily increased. The table below shows number of referrals from 2010-2014. Over 100 pancreatic resections
are performed annually for malignant or pre-malignant lesions. Similar increases in activity have been seen in all
the HPB disease categories with approximately 120 liver resections performed per year. Laparoscopic resection
techniques are frequently employed for both liver and distal pancreatic resection. Advanced liver resection
techniques such as two-stage hepatectomy, vascular/caval resection, and in situ hypothermic perfusion are all
performed. 48 liver transplants were performed in 2014 with an increasing proportion being accounted for by
patients with hepatocellular carcinoma as the primary indication.
Close interaction with Diagnostic and Interventional Radiology and Pathology services is crucial to the delivery
of HPB services. The Interventional Radiology (IR) group delivers an increasing number of treatments for
hepatocellular carcinoma with TACE and local ablative techniques, principally radiofrequency and microwave
ablation. IR also faces an increasing workload to support pancreatic cancer patients with biliary drainage
procedures and techniques such as portal vein embolization to support extensive liver resection procedures.
Increasing complexity of multimodality treatment schedules for cancer patients requires seamless integration
between surgery and medical and radiation oncology treatments. Neoadjuvant chemoradiotherapy strategies
are frequently used in patients with pancreatic adenocarcinoma. The unit has also accrued significant experience
with neoadjuvant chemoradiotherapy for patients with cholangiocarcinoma who subsequently undergo liver
transplantation (Mayo protocol). A number of trials for pancreatic cancer patients and patients with metastatic
colon cancer are currently recruiting.
2014 National Surgical Centre for Pancreatic Cancer Activity Levels
NSCPC
No of referrals 2010
276
381
426
456
485
Surgery/Procedure
2013
2014
Whipples Procedure
74
66
Other Pancreatic resections
26
43
100
109
Laparotomy only
19
17
Exploratory Laparoscopy
20
37
Symptom relieving bypass
13
4
Other surgeries Pancreas/Bile ducts
56
47
TOTAL OTHER SURGICAL PROCEDURES
108
106
TOTAL ALL SURGICAL PROCEDURES
208
214
TOTAL RESECTIONS
Page 22
Research
The concentration of clinical material in the HPB Unit has supported an increase in research and clinical trial
activity. A number of trainees have undertaken research projects in collaboration with Prof Cliona O’Farrelly in
Trinity College Dublin. Ms Fiona Hand held the role of research fellow in 2014.
To support research activity a biobank has been instituted for collection of tissue from resected pancreatic and
liver tumours. This, combined with an effective clinical database, will provide a proper basis for future molecular
studies on pancreatic and liver cancer. Collaborative studies are ongoing with the pancreas cancer research
group at Johns Hopkins Medical Center (analysis of pancreatic cyst fluid) and with the National Institute for
Cellular Biotechnology at Dublin City University (development of pancreatic-derived tumour xenografts). These
studies are currently leading to a number of presentations at international meetings
Page 23
Lung Cancer
Introduction
Lung Cancer is the fourth most common cancer in Ireland, accounting for 12.1% of all invasive cancers in men
and 10.4% of such cancers in women. Annually, 1,300 men and 973 women were diagnosed with Lung Cancer
within 2010-2012 (Annual Report of the National Cancer Registry, December 2014).
The Rapid Access Lung Clinic (RALC) is one of the eight NCCP centres for the diagnosis of Lung Cancers in
Ireland. This comprehensive service reviews patients with a suspected diagnosis of lung cancer within a 2
week period of referral, as per the recommendations of the NCCP and the Irish Thoracic Society.
The Rapid Access Lung Clinic receives referrals from General Practitioners, internal hospital teams and
external hospitals. The goal of this service is to ensure the early diagnosis and timely treatment of people with
lung cancers, improving national surgical and survival rates and impacting patient outcomes.
Activity
A Rapid Access Lung Clinic (RALC) for new referrals is held each Monday.
Lung Cancer Clinic Activity 2013-2014
Rapid Access Clinic St Vincent’s University Hospital
2013
2014
Total Designated Cancer Outpatient clinics
140
204
New Patients
209
307
Review Patients
333
329
Total Number of Patients Seen
611
636
Total Number of Primary Lung Cancers
109
126
33
55
4
4
146
185
Total Number of Secondary Lung Cancer
Other Malignancy
Total Cancer Diagnoses
Multidisciplinary Meetings 2014
Frequency of MDM
Weekly
Page 24
No. of MDMs in 2014
No. of patients diagnosed
45
185
Patient Age Range at Diagnosis
80
70
60
50
40
30
20
10
0
21-30 yrs
31-40 yrs
41-50 yrs
51-60 yrs
61-70 yrs
71-80 yrs
81-90 yrs
91-100 yrs
Lung and Cardiothoracic Interventional Procedures 2014
All diagnostic procedures for patients with a suspected lung cancer are carried out within the ambulatory day
care service as day case procedures. Investigations include CT imaging, Bronchoscopy, EBUS (endobronchial
ultrasound lymph node sampling), CT guided Lung Biopsy and PET scanning in an external intuition. Facilitating
these investigations requires huge support from the Endoscopy, Radiology, Day Care services and Histopathology
departments.
All patients with a definitive diagnosis of Lung Cancer are discussed at a weekly Multidisciplinary Lung Cancer
meeting held each Monday morning to ensure the evidence based plan of treatment is recommended for the
individual patient (Irish Thoracic Society 2009).
From September 2010, Lung Cancer surgeries were re-located to the Mater Misericordiae University Hospital
(MMUH). In 2014, the NCCP national dataset for lung cancer indicated that 85 patients had a primary lung cancer
resection at MMUH. Radiation therapy for SVUH patients is performed via the St Lukes Radiation Oncology
Network (SLRON). In 2014, the NCCP national dataset for lung cancer indicated that 166 patients with a primary
lung cancer had radical radiation therapy at SLRON.
Staffing
The Rapid Access Lung Cancer Service is led by Lead Clinician, Prof Michael Keane. There are nine Respiratory
Consultants involved in the Service on a two weekly rota covering the Monday RALC, following the patients
through their investigations and seeing patients in their designated return RALCs.
Prof Jonathan Dodd is the designated Consultant Radiologist for the NCCP Rapid Access Lung Cancer Service. In
total, four Consultant Radiologists are involved in the weekly Lung Cancer MDT meetings.
There is a designated 0.5 WTE Histopathology post for the Lung Cancer Service, presently covered by three
Consultant Histopathologists, led by Dr Aurelie Fabre.
There are two Consultant Cardio-Thoracic Surgeons, Mr M Tolan and Mr David Healy, working between SVUH and
MMUH for surgical treatment of Lung Cancers.
There is one Medical Oncologist, Dr Emer Hanrahan, and two Radiation Oncologists, Prof J Armstrong and Dr O
Salib, involved in the medical and radiation oncology treatment of Lung Cancer patients.
There is 1.5 WTE Lung Cancer Clinical Nurse Specialists, Cecilia Boland (one WTE) and Patsy Ryan (0.5 WTE, post
shared with Melanoma Service).
There is a 0.75 WTE Data Manager for the Lung Cancer Service, Sue Canny (shared with Melanoma).
There is a dedicated Rapid Access Lung Clinic Administration Manager, Georgina O’Reilly, who co-ordinates the
new and return RALC and manages the administration workload of the Rapid Access Lung Cancer Service.
Page 25
Neuroendocrine
Tumours (NET) Service
The Neuroendocrine Tumour Service in SVUH was established as the National NET service by NCCP in 2014.
The service is headed by Professor Dermot O’Toole (National Lead in NET) and Professor Donal O’Shea. This
unique service has a weekly consultant-staffed multidisciplinary outpatient clinic on a Friday morning led by
Professor O’Toole and a dedicated Clinical Nurse Specialist in Neuroendocrine tumours (Ms Lisa Cullen). The
clinic is attended by one of the HPB Surgeons, an Endocrine Surgeon (Ms Ruth Prichard), and two Consultant
Endocrinologists (Professor Donal O’Shea and Dr Rachel Crowley).
The NET Service also has expanded to include hereditary NET disorders (such as MEN-1, VHL and
paragangliomas) and in addition to surveillance and managing patients with NET provides counselling to gene
carriers.
There is a fortnightly NET MDT and over 320 patients’ cases were discussed over the past year; with more than
200 new individual patients annually. In addition to the consultants involved in the NET Clinic, the MDT has
two dedicated radiologists (Dr Stephen Skehan and Dr Conor Collins, both with experience in diagnostic and
interventional radiology and nuclear medicine) as well as two dedicated NET pathologists (Dr Niall Swan and
Professor Kieran Sheahan).
Page 26
Initiatives in Year 2014/15
The NET Service in SVUH was pleased to host the Irish NET patient group annual meeting on 8th
of November 2014. The NET Patient Network is an organisation of NET patients in Ireland that
was established in 2012 to provide information and support services for NET patients in Ireland
(http://www.netspatientnetwork.ie) and opened by the interim lead of NCCP, Dr Jerome Coffey. The NET
Patient Network gathered medical experts from Galway, Cork, Dublin and Dr Dan Granberg and Mrs Riselda
Granberg from Uppsala University Hospital in Sweden to participate in an interactive open panel discussion.
The St Vincent’s NET service in conjunction with Trinity College (Prof O’Toole as co-chair with Prof James Yao,
from MD Anderson, Texas) also hosted a large international educational meeting NETConnect in April 2015
with over 200 participants gathering to participate in an interactive educational programme involving many
lead international experts in NET.
A NET Support Fund was also established within the St Vincent’s Foundation
(http://www.stvincentsfoundation.ie/donate/).
Members of International Working group (Prof KC Conlon & Prof D O’Toole) for recommendations for
management of patients with neuroendocrine liver metastases, London 2014.
Members of International Working group (Dr M Quinn, Cardiologist & Prof D O’Toole) for 1st International
Congress devoted to Carcinoid Heart Disease.
Total number of cases and incidence rates for invasive NETs (all subtypes combined), 1994-2010
Figure 1
Total number of cases and incidence rates for invasive NETs (all subtypes combined), 1994-2010
120
100
4.0
80
3.0
60
2.0
40
1.0
0
20
1994
1995
1996
cases female
1997
1998
1999
2000
cases male
2001
2002
2003
rate female
2004
2005
2006
2007
2008
2009
2010
0
rate male
Page 27
Total cases per year
rate (cases per 100,000 per year)
5.0
Head & Neck Cancer
Introduction
In 2014, there were 121 new cases of Neck and Head Cancer diagnosed at SVUH.
Head and Neck cancer accounts for approximately 5% of all cancer diagnosed worldwide.
Head and Neck Cancer is the ninth most common cancer in Ireland, accounting for 1.6% of all malignant
neoplasms in women and 4.0% in men.
Head and Neck Cancer incorporates cancers at 17 separate sites in the mouth, pharynx, larynx, middle ear
and nasal sinuses.
The risk factors associated with head and neck cancer include the following:
-
Alcohol: Oral cavity, pharynx, oesophagus, larynx
-
Tobacco: Oral cavity, pharynx,oesophagus, larynx
-
Thorium dioxide: Paranasal sinuses
-
Chromium dust/fumes: Nasal cavity and sinuses
-
Leather working: Nasal cavity and sinuses
-
Nickel dust/fumes: Nasal cavity and sinuses
-
Wood dust: Nasal cavity and sinuses
-
Iron deficiency: Post cricoid carcinoma
-
Salt fish: Nasopharynx
Page 28
Viruses associated with head and neck cancer include the following:
-
Human papilloma virus (HPV): Oral cavity, tonsil and larynx
-
Herpes simplex virus (HSV): Oral cavity, tonsil and larynx
-
Epstein-Barr virus (EBV): Nasopharyngeal carcinoma
In addressing the need to develop the Head and Neck Cancer Service at SVUH, the following challenges
dominate:
-
Collaboration, both nationally and internationally
-
The need for the centre at SVUH to be appropriately resourced
-
The need for a Data Manager to record pre-treatment staging, performance status and co-morbidity,
thus giving the service the ability to deliver risk adjusted outcomes
-
The need to ensure that every patient with Head and Neck Cancer is discussed at a specialised MDT
Multidisciplinary Team
Head And Neck Cancer MDT
A multidisciplinary approach is the key to effective management of head and neck cancer patients. This
approach helps to achieve excellence in patient care, and contribute to one of the expected outcomes of
treatment – a reasonable quality of life for this patient group.
From the clinician’s point of view the establishment of a Head and Neck MDT will provide a forum of
support and advice from peers to discuss difficult cases and to gain consensus on a pathway of care.
For the patient, the meeting ensures that their treatment is based on the combined experience of all the
relevant consultants present, who bring all of their academic research and experience to bear on their
decisions.
The MDT approach requires appropriate consultation input from the following disciplines:
-Otolaryngologist
-
Maxillofacial Surgeon
-
Plastic Surgeon
-
Medical Oncologist
-Radiotherapist
-
Clinical Nurse Specialist
-
Nursing Team
-
Palliative Care Team
-Dietician
-
Speech Therapist
-Prosthetist/Prosthodontist
-
Dentist/Dental Hygienist
-Psychologist/Counsellor
-Physiotherapist
-
Social Worker
-
Pastoral Care
Page 29
6%
Oesophagus
Larynx
Maxilla
10%
Gender Distribution
Nasopharynx
Nose
Palate
7%
Gender For Head And Neck Cancer Cases
42%
MALE
55%
Parotid gland
Head and Neck Cancer affects more males than females.
In 2014,
Pharynx
of the 121 newly diagnosed cases, the gender distribution
shows
Salivary gland
that 67 were male, compared with 54 female diagnoses.
Thyroid
21%
FEMALE
45%
Tongue
Tonsil
Age6%Profile
2%
Vocal Cord
3%
6%
1%
1%
1%
1%
Age At Diagnosis
The age distribution for Head and Neck Cancer show that most diagnoses were made in those aged 50
years upwards.
50% of men were over 50 years compared to 33% of women.
AGE
20-30yrs
30-40yrs
40-50yrs
50-60yrs
60-70yrs
70-80yrs
80-90yrs
90-100yrs
Male
1
5
1
14
15
20
9
2
Female
3
6
5
3
16
12
8
1
TOTAL
4
11
6
17
31
32
17
3
35
MALE
30
15
85
20
FEMALE
25
20
15
14
10
9
16
12
2
5
12
5
0
Page 30
1
6
8
1
5
3
3
20-30
YEARS
30-40
YEARS
2
40-50
YEARS
50-60
YEARS
2
60-70
YEARS
70-80
YEARS
80-90
YEARS
12
2
1
90-100
YEARS
Histological Types of Head and Neck Cancer
Histology for Head and Neck Cancer Cases
42% of the cancers of the head and neck were of the Oesophagus, with the Thyroid accounting for a
further 21%.
6%
Oesophagus
Larynx
10%
Maxilla
Nasopharynx
Nose
Palate
7%
42%
Thyroid
Tongue
Tonsil
Vocal Cord
21%
3%
6%
6%
TYPE
OCCURRENCES
PERCENT
Oesophagus
51
42%
Larynx
1
1%
Maxilla
1
1%
Nasopharynx
1
1%
Nose
2
2%
Palate
1
1%
Parotid Gland
7
6%
Pharynx
2
2%
Salivary Gland
1
1%
Thyroid
25
21%
Tongue
9
7%
Tonsil
12
10%
Vocal Cord
8
7%
50
45
FEMALE
45%
1%
1%
1%
1%
2%
MALE
55%
Parotid gland
Pharynx
Salivary gland
51
Number
of patients
40
35
30
25
25
20
15
10
5
0
1
1
1
1
1
7
9
1
1
12
8
Page 31
Radiology
Introduction
Diagnostic and Interventional Radiology Cancer Imaging is provided by the Radiology Department at SVUH.
This comprises of 16 consultants, 50 radiographers, 15 nurses and 13 specialist registrars. The Department
currently performs approximately 200,000 examinations per annum and a significant amount of the complex
departmental activity relates to cancer. The Department has seen extraordinary expansion since it moved to the
entirely digital Department in 2006. It now covers imaging for several off-site hospitals in addition to the main
hospital campus:
St Michael’s Hospital, St Columcilles Hospital and St Vincent’s Private Hospital
St Luke’s Hospital – the National Radiotherapy Centre
The National Maternity Hospital
The Royal Eye and Ear Hospital – National Referral Centre for Ophthalmology and Otolaryngology
Breast Check – National Breast Cancer Screening Programme
National and Regional Imaging Referral Centre
The Department of Radiology provides Cancer Imaging Expertise for several National and Regional Referral
Centres at St Vincent’s University Hospital including:
NATIONAL
1. National Liver Transplant Unit
2. National Pancreatic Cancer Surgical Centre
3. National Adult Referral Centre for Cystic Fibrosis
4. Breast (National Screening Centre and Regional Symptomatic Unit)
REGIONAL
1. Rapid Access Lung Cancer Referral Centre
2. Rapid Access Prostate Cancer Centre
3. Regional Vascular Centre
4. Regional Oncology Centre
Page 32
Radiology Oncology Multidisciplinary Imaging Team SVUH 2014
Breast Cancer:
Dr Ann O’Doherty, National Breast Cancer Lead
Dr Suzanne Shine, Breast Cancer Imaging
Dr Sorcha McNally, Breast Cancer Imaging
Lung Cancer: Prof Jonathan Dodd, Lung Cancer Imaging
Dr Conor Collins, Lung Cancer Imaging
Dr Stephen Skehan, Lung Cancer Imaging
Dr Deirdre Moran, Lung Cancer Imaging
Hepatobiliary/Pancreatic: Dr Ronan Ryan, Hepatobiliary/Pancreatic Cancer Imaging
Prof Dermot Malone, Hepatobiliary/Pancreatic Cancer Imaging
Dr Robin Gibney, Hepatobiliary/Pancreatic Cancer Imaging
Dr Eric Heffernan, Hepatobiliary/Pancreatic Cancer Imaging
Dr David Brophy, Hepatobiliary/Pancreatic Cancer Imaging
Dr Jeff McCann, Hepatobiliary/Pancreatic Cancer Imaging
Dr Colin Cantwell, Hepatobiliary/Pancreatic Cancer Imaging
Dr Stephen Skehan, Hepatobiliary/Pancreatic Cancer Imaging
Colorectal:
Dr Robin Gibney, Colorectal Cancer Imaging
Dr David Brophy, Colorectal Cancer Imaging
Dr Conor Collins, Colorectal Cancer Imaging
Dr Stephen Skehan, Colorectal Cancer Imaging
Dr Suzanne Shine, Colorectal Cancer Imaging
Dr Deirdre Moran, Colorectal Cancer Imaging
Sarcoma:
Dr Eric Heffernan, Sarcoma Imaging
Hepatocellular:
Prof Dermot Malone, HCC Imaging
Dr Robin Gibney, HCC Imaging
Dr Ronan Ryan, HCC Imaging
Dr Stephen Skehan, HCC Imaging
Dr Colin Cantwell, HCC Imaging
Dr Jeff McCann, HCC Imaging
Urology:
Dr Deirdre Moran, Prostate Cancer Imaging
Dr Conor Collins, Prostate Cancer Imaging
Dr David Brophy, Prostate Cancer Imaging
Dr Robin Gibney, Prostate Cancer Imaging
Gynecology:
Prof Risteard O’Laoide, Women’s Cancer Imaging
Dr David Brophy, Women’s Cancer Imaging and Interventional
Dr Suzanne Shine, Women’s Cancer Imaging
General Oncology: Dr Conor Collins, Oncology Specialist, PET-CT Specialist
NeuroOncology:
Dr Ronan Killeen, NeuroCancer Specialist, PET-CT Specialist
General Oncology:
Dr Stephen Skehan, Oncology Specialist, PET-CT Specialist
Hemo-oncology:
Dr Conor Collins, Oncology Specialist, PET-CT Specialist
Lymphoma:
Neuroendocrine:
Dr Stephen Skehan, Oncology Specialist, PET-CT Specialist
Thyroid:
Dr Stephen Skehan, Thyroid Cancer Imaging
Prof Dermot Malone, Thyroid Cancer Imaging
Dr Robin Gibney, Thyroid Cancer Imaging
Dr Ronan Killeen, Ocular Malignancy, Head and Neck Imaging
ENT MDT:
Dr Ronan Killeen, Ocular Malignancy, Head and Neck Imaging
Page 33
Interventional Radiology Oncology Team
Dr Ronan Ryan
Dr David Brophy
Dr Jeff McCann
Dr Colin Cantwell
The Interventional Oncology Group in SVUH is a dynamic, core unit of the Department of Radiology, providing
daily routine and emergency interventional radiology for patients with cancer. Numerous procedures are
carried out by the IR Oncology team including the majority of percutaneous biopsy procedures in the hospital
for tissue diagnosis and genetic mutation work-up. The team also provides routine and emergency biliary
drainages, both for diagnosis (brushings), palliative drainage and access for radiotherapy. More specialist
procedures include Portal Vein Embolization, and highly specialized procedures including TransArterial
ChemoEmbolization (TACE) for:
Hepatocellular carcinoma
Neuroendocrine carcinoma
and Radiofrequency Ablation (RFA) for:
Hepatocellular carcinoma
Renal Cell carcinoma
Liver metastases
The team also provides clinical care to cancer patients in both the inpatient and outpatient settings.
The following figure shows the increase in TACE and RFA procedures for cancer performed over the last three
years:
50
TACE
45
40
35
RFA
30
25
20
15
10
5
0
Page 34
2012
2013
2014
Radiology Nursing Oncology Team
The Radiology Nursing team play a significant role in both the diagnostic and treatment aspects of the Cancer
Services in the Department. Some examples of the comprehensive care given by the Radiology Nursing
Team include the complete management and care of Rapid Access Prostate Clinic patients from the time of
the decision to biopsy on the day of the clinic visit, to discharge a number of hours later from the Radiology
Department. Rapid Access Lung Clinic patients are admitted to the CT Department as Radiology Day Cases and
monitored and cared for throughout the day by Radiology Nurses. Biopsy is performed and the patient is closely
monitored over the next four hours. If recovery is satisfactory there is a combined medical and nursing discharge
of these patients.
Multidisciplinary Team Oncology Conferences (MDTs)
Multidisciplinary Team Cancer meetings make up a major part of the Radiology Department activity (Table 1):
MDT
Frequency
Duration
(hours)
Lung
Weekly
1.5
Colorectal
Weekly
1
Pancreatic
Weekly
2
Urology
Weekly
1
Haematology
Weekly
1
Gynaecology
Every 2nd Week
1
Oncology
Weekly
1
Lymphoma
Weekly
1
Thyroid
Monthly
1
Breast Check
Weekly
2
Symptomatic Breast
Weekly
1
Sarcoma
Every 2nd Week
1
ENT
Every 2nd Week
1
Neuroendocrine
Every 2nd Week
1
National Cancer Control Program (NCCP) Imaging Leads
2014 saw ongoing involvement of the SVUH Radiology Group in National Advisory Committees for the NCCP.
There are six consultants on NCCP committees:
Prof Jonathan Dodd on the Radiology Advisory Group for the NCCP for Lung Cancer
Dr Ronan Ryan on the Radiology Advisory Group for the NCCP for Pancreatic Cancer
Dr Ronan Ryan on the Radiology Advisory Group for the NCCP for Hepatobiliary Cancer
Dr Deirdre Moran on the Radiology Advisory Group for the NCCP for Prostate Cancer
Dr Stephen Skehan on the Radiology Advisory Group for the NCCP for Colon Cancer
Dr Ann O’Doherty on the Radiology Advisory Group for the NCCP for Breast Cancer
Dr Eric Heffernan on the Radiology Advisory Group for the NCCP for Sarcoma Section
Page 35
Clinical Activity
The Department of Radiology has seen a tremendous increase in complex Cancer Imaging since 2006. The
department has seen a progressive rise of approximately 2-4% since the move to the new Department. The
majority of the increase in cancer imaging has been in CT, but similar increases are also evidenced in the other
complex imaging modalities. The graphs below show the increase in complex imaging modalities since 2011:
35000
30000
2011
25000
2012
20000
2013
15000
2014
10000
5000
0
CT
Page 36
US
MRI
Histopathology
Introduction
Histopathology provides a Histopathology and Cytopathology service to St Vincent’s University Hospital. The case–
mix is increasingly complex with an emphasis on Oncologic Pathology (in particular colorectal, breast, pancreatic
and hepatobiliary cancer). Laboratory resources are devoted to high quality analysis and reporting on these
patients’ biopsies and resected specimens. Immense experience has been built up both amongst the Consultant
Histopathology and Medical Scientific staff in the analysis of these specimens. SOPs and standardised reporting has
been in place for many years and ancillary tests including Hormone Receptor analysis, HER2 analysis, Mismatch repair
Immunohistochemistry, and RAS/BRAF molecular analysis are performed on a routine basis.
Multidisciplinary Team meetings take place on a weekly/ monthly basis relating to patients from Oncology, Breast,
BreastCheck, Gastrointestinal, Urology, Liver, Skin, Haematopathology, ENT, Genitourinary, Respiratory, Thyroid, and
Melanoma services.
Approximately 20% (5,000) of all specimens (25,000) are discussed at MDTs on an annual basis. These conferences are
consultant-led & delivered by all the following consultant staff: Dr T Crotty, Dr C Quinn, Prof K Sheahan, Dr A Fabre,
Dr N Swan, Dr D Gibbons, Prof S Kennedy, Dr N Nolan and Dr E Mooney.
MDT Meetings / Conferences
Monday
7.00am
7.30am
8.00am
9.30am
1.00pm
Soft Tissue (2 x month)
Melanoma (2 x month).
Lung Cancer MDM
Bone Marrow Morphology CPC
Breast screening MDM (Merrion Unit)
Tuesday
7.30am
8.30am
1.00pm
Colorectal Cancer MDM
Urology MDM
Thyroid (every 3 months)
Wednesday
7.15am
8.00am
10.00am
11.30am
Pancreas Cancer MDM
Surgical Grand Rounds (Old Lecture Hall)
Gynaecology (bi-weekly)
Dermatology CPC
Thursday
7.00am
8.00am
10.00am
10.30am
1.15pm
Lymphoma MDM
Medicine Grand Rounds (Old Lecture Hall)
Renal (Monthly, last Thursday)
Liver Medical CPC
GI Medical CPC
Friday
7.00am
8.15am
NET (1st & 3rd) / Hepatobiliary (2nd and 4th) MDM
Breast MDT (Old Lecture Hall)
Page 37
CURRENT HISTOPATHOLOGY SERVICES
ONGOING CANCER SERVICE DEVELOPMENT IN
HISTOPATHOLOGY SVUH
Diagnostic and Prognostic services including specific testing
for suitability of specific Therapeutic agents
Immunocytochemistry:
Provides a range of 128 antibody tests, mainly tumour
markers.
Ongoing optimisation of new biomarkers for
diagnosis, prognosis and treatment decisions.
Molecular Her-2 FISH for Breast cancer treatment,
provision of testing.
Molecular testing for mutations in BRAF and k-ras genes in
Colorectal Cancers & Melanoma.
Next-generation sequencing platforms are in the
process of being validated to ensure more efficient
screening for actionable tumour mutations.
Non-Gynae Cytology:
Modern ThinPrep system is in use since 2004. Preparation,
screening and diagnosis of malignancy from fluid and Fine
Needle Aspirate (FNA) samples, Bronchial, Breast, Abdominal,
Pleural, CNS etc.
Further development of Immunocytochemistry &
molecular tests.
An onsite EBUS service is provided for Pancreatic & Lung
cancer patients.
Cancer Specimen Cut-up:
Reception and numbering of specimens from Endoscopy,
Theatre, Ward and GPs.
Specimen Description; Intraoperative procedures including
Frozen Sections and Assessment of Margins; X-ray of
tumours; Monitoring of Radioactivity; Photography; Inking;
Weighing; Decalcification; Gross Cut-up, Fixation.and Paraffin
Processing; Specimen Retention and correct disposal. Triage &
liquid nitrogen freezing of tissue for biobanking.
Increasing role of Medical Scientists in Cut-up, in
line with Royal College of Pathologist / Institute
of Biomedical Scientists’ guidelines on Advanced
Practice in Histological Dissection.
Tissue & Slide Preparation for Microscopy:
Specimen Embedding, Microtomy, Morphological staining and
Quality Control.
Order comms & automated processing will
improve safety & efficiency.
CPA Accredition of SVUH Histopathology Department
Histopathology Accredited since 2004.
Continuing need to ensure compliance with INAB
Quality Assessment and Audit
Histopathology laboratory is a leader in National Quality
Improvement programme
Existing and additional staff (Medical, Scientific &
Clerical) contribute to this activity.
CURRENT STAFFING
ADDITIONAL STAFFING PLANNED
Consultant Histopathologists
9
1
NCHDs
8
0
Clerical/Secretarial
4
BreastCheck Clerical
1
Chief Medical Scientist
1
Senior Medical Scientists
6
BreastCheck Medical Scientists
3
Medical Scientists
8
2 Medical Scientists
Laboratory Aides
4
1 Laboratory Aide
Page 38
Sarcoma
Introduction
In Ireland approximately 200-250 adults are diagnosed with some form of
sarcoma each year. The most common is soft tissue sarcoma, which account
for 1% of all malignancies in adults. Ireland has an incidence of 4.5 per
100,000 person-years. This is at the higher end of the international incidence
range, making centralisation of these rare cancers very important - in order
to concentrate the expertise in the hope of delivering quality contemporary
care.
About 60% of soft tissue sarcomas begin in an arm or leg, 30% start in the
torso or abdomen and 10% occur in the head or neck. With the purpose
of concentrating the expertise to care for these patients in mind, the
multidisciplinary team meeting (MDT) was started in 2013. It builds on
the previous SVUH MDT allowing a ‘hub and spoke’ model of soft tissue
sarcoma (STS) care to be formalised. As well as the expertise already in St
Vincent’s, practitioners with specialist interest in STS are taking part in the
MDT discussion. More than five hospitals and respective referral bases are
represented at the bi-weekly meeting.
The inaugural meeting of the Irish Sarcoma Group (ISG) took place in
November 2014, organised by members of the SVUH MDT. Chaired by Dr
Charles Gillham, over 150 delegates attended, representing all the major
disciplines involved in diagnosing, treating and caring for people, both
children and adults, with Sarcoma. The meeting was opened by Finance
Minister Mr Michael Noonan, TD, and brought together the Irish specialists
with specialist interests in sarcoma. At the meeting a web based referral
structure into the ISG MDT at SVUH was initiated. The meeting also
focused on the major areas of interest in STS including: Epidemiology
and Diagnosis, Surgical Management, Adjunctive Therapies and Bone
Sarcomas. A major session on ‘Developing a National Service’ was
attended by the new Director of the National Cancer Control Programme,
Dr Jerome Coffey. Plans for a yearly ISG meeting were confirmed soon
after the meeting closed.
Sarcoma MDT at SVUH
A core bi-weekly multidisciplinary team meeting is held where all
confirmed new, suspected or recurrent sarcoma cases are discussed
to formulate a management plan. In 2014, 80 new diagnoses were
discussed.
Mr Gary O’Toole, Mr Sean Dudeney, Ms Amy Gillis, Mr David Healy and
Prof Paul Ridgway provide surgical oncology input. The designated
Musculoskeletal Radiologist for the MDT is Dr Eric Heffernan. Dr Aurelie
Fabre and Dr Tom Crotty provide the specialist pathology input. Dr
Charles Gillham is the Specialist Radiation Oncologist and Dr Alexia
Bertuzzi is the Medical Oncologist. Ms Una Hayden is the Clinical Nurse
Specialist who coordinated the MDT in 2014.
Mr Stewart Thompson from SVUH ICT has been instrumental in the
development of the Excelicare MDT package, which is now built and due
for roll out in 2015.
The Sarcoma Group in SVUH has been in place for more than one year,
with referrals and work volumes continuing to increase.
Page 39
In an effort to ensure that this Group evolves, has the appropriate governance and quality assurance
processes, and becomes formally accredited the following next steps are essential:
Develop formal Irish Sarcoma Group guidelines
Develop KPIs
Establish multidisciplinary clinics at SVUH
Implement a Quality Assurance Program
Collaboration, both nationally and internationally
Prospective Clinical trial with Chemo (trabectedine) and RT in metastatic STS
Retrospective observational study about incidence and diagnosis of bone sarcoma
Analysis of retrospective incidences of Bone Metastases in STS
Sarcoma Current and Future
Soft-tissue sarcomas (STS) are a group of cancers that begin in the tissues that support and connect the body,
such as fat cells, muscle, nerves, tendons, the lining of joints, blood vessels, or lymph vessels. As a result, STS
can occur almost anywhere in the body. When an STS is small, it can go unnoticed because it usually does not
cause problems in the early stages. Most GPs will only deal with 1-2 sarcomas in their careers, so recognition
and referral are key steps in the management.
Bone Sarcoma is very rare with approximately 40 new cases diagnosed in Ireland each year, with incidences
slightly higher in males than in females, and is very likely to be diagnosed in children. They are sometimes
discussed at the SVUH MDT and Crumlin MDTs. The three main types of Bone Sarcoma include: Osteosarcoma,
Ewing’s Sarcoma and Chondrosarcoma.
The classification of these tumours continues to evolve over time. They represent a different group to the
epithelial carcinomata, that have a different classification. Although the surgery for these cancers take place
at a number of different hospitals in Dublin, the diagnostic expertise in terms of radiology and pathology is
centralised at SVUH. The pathologists and radiologists collaborate with various other diagnostics groups
including Our Lady’s Hospital for Sick Children when children and young adults are diagnosed.
The plan for 2015 is to increase the throughput of patients at the Sarcoma MDT and to further build on the
first 18 months of the new structures. SVUH management has been very supportive of building a robust
governance structure and have committed to providing coordinators and data management support in 2015.
Page 40
Sarcoma Histological Composition at SVUH 2014
Sarcoma Subtypes
The breakdown of the 80 patients diagnosed with Sarcoma in SVUH is as follows:
SARCOMA TYPE
OCCURRENCES
PERCENT
Leiomyosarcoma
3
4%
High Grade Leiomyosarcoma
6
8%
High Grade Uterine Leiomyosarcoma
1
1%
Low Grade Uterine Leiomyosarcoma
2
3%
Liopsarcoma
1
1%
High Grade Liposarcoma
1
1%
Low Grade Liposarcoma
2
3%
Myxoid Liposarcoma
2
3%
High Grade Pleomorphic Sarcoma
16
20%
Synovial Sarcoma (SS)
7
9%
Ewing Sarcoma
1
1%
Endometrial Stromal Sarcoma
2
3%
Undifferentiated Endometrial Sarcoma
1
1%
Angiosarcoma
1
1%
High Grade Epithelioid Angiosarcoma
2
3%
Atypical Lipomatous Tumour
4
5%
Chondrosarcoma
2
3%
High Grade Chondrosarcoma
1
1%
Low Grade Chondrosarcoma
2
3%
High Grade Mesenchymal Chondrosarcoma
1
1%
Dermatofibrosarcoma
1
1%
Epitheliod Sarcoma
1
1%
Fibrosarcoma
1
1%
Myxofibrosarcoma
1
1%
Low Grade Fibromyxosarcoma
1
1%
GIST Sarcoma
1
1%
High Grade Osteosarcoma
5
6%
Low Grade Osteosarcoma
1
1%
Parosteal Osteosarcoma
1
1%
Soft Tissue Osteosarcoma
1
1%
High Grade Sarcoma
3
4%
MPNST
2
3%
Myxoma
1
1%
Round Cell Sarcoma
1
1%
Solitary Fibrous Tumour (SFT)
1
1%
Page 41
Sarcoma Subtypes
The breakdown of the primary sarcoma sites and its metastases is as follows:
SARCOMA TYPE
PRIMARY SITE
METASTASES
Leiomyosarcoma
1 x Left Knee
1 x Shoulder
1 x Uterus
1 x Groin
1 x Right Leg
1 x Thigh
2 x Uterus
1 x Uterus
2 x Uterus
1 x Supra Pubic Area
1 x Pelvis
1 x Abdomen
1 x Retroperitoneal
1 x Left Knee
1 x Left Thigh
2 x Left Forearm
1 x Groin
1 x Right Knee
1 x Right Leg
3 x Left Thigh
6 x Right Thigh
2 x Shoulder
2 x Right Foot
1 x Groin
1 x Right Leg
1 x Lung
2 x Left Thigh
1 x Chest Wall
1 x Endometrium
1 x Uterus
1 x Uterus
1 x Breast
1 x Scalp
1 x Ischio Rectal Fossa
1 x Back
1 x Left Forearm
2 x Right Thigh
2 x Chest Wall
1 x Tibia
1 x Chest Wall
1 x Right Leg
1 x Shoulder
1 x Back
1 x Groin
1 x Right Thigh
Lung
Liopsarcoma
Myxoid liposarcoma
Ewing Sarcoma
Angiosarcoma
Chondrosarcoma
Dermatofibrosarcoma
Epitheliod Sarcoma
Fibrosarcoma
Myxofibrosarcoma
GIST Sarcoma
High Grade Sarcoma
MPNST
Myxoma
Round Cell Sarcoma
Page 42
1 x Left Thigh
1 x Right Buttock
1 x GIST
1 x Humerus
1 x Knee
1 x Pelvis
1 x Shoulder
1 x Sternum
1 x Right Knee
1 x Shoulder
1 x Right Thigh
1 x Back
1 x Presacral Mass
1 x Retroperitoneal
1 x Neck
1 x Shoulder
1 x Left Thigh
1 x Retroperitoneal
1 x Groin
Lung
Lung/Abdominal
Soft Tissue
Lung
Abdominal Lesion
Abdominal Wall
Lung/Bone/Soft Tissue
Lung/Retroperitoneal
Lung
Lung/Retroperitonea
Lung
Lung/Brain
Groin
Lung
Lung
Bone Marrow
Lung
Lung
Bone
Lung
Lung
Lung
Lung
Lung/Scalp/Groin
16
14
12
10
8
6
4
2
Round Cell Sarcoma
Myxoma
Myxoid liposarcoma
MPNST
Myxofibrosarcoma
Liopsarcoma
Leiomyosarcoma
High Grade Sarcoma
Fibrosarcoma
GIST Sarcoma
Ewing Sarcoma
Epitheliod Sarcoma
Chondrosarcoma
Dermatofibrosarcoma
Angiosarcoma
0
Sarcoma Gender Distribution
Sarcoma Cancer affects more males than females. In 2014, of the
80 newly diagnosed cases, the gender distribution shows that 45
were male, compared with 35 female diagnoses.
FEMALE
44%
MALE
56%
Sarcoma Age Profile
Age at Diagnosis
The age distribution for Sarcoma Cancer shows that 64% of all patients were aged between 50 and 80 years at
the time of diagnosis. 51% of women were aged 50 to 70 years compared with 44% of men.
AGE
10-20yrs
20-30yrs
30-40yrs
40-50yrs
50-60yrs
60-70yrs
70-80yrs
80-90yrs
90-100yrs
TOTAL
Male
2
1
6
6
9
11
8
2
0
45
Female
2
1
2
4
11
7
5
2
1
35
TOTAL
4
2
8
10
20
18
13
4
1
80
22
MALE
20
9
18
11
16
FEMALE
14
12
85
8
10
11
6
8
6
6
4
2
0
7
12
2
5
2
4
2
1
1
2
10-20
YEARS
20-30
YEARS
30-40
YEARS
12
22
40-50
YEARS
50-60
YEARS
60-70
YEARS
70-80
YEARS
12
22
80-90
YEARS
1
90-100
YEARS
Page 43
Skin Cancer
Introduction
Non-melanoma skin cancer is the most common cancer in Ireland. The incidence of basal cell cancer in
particular is increasing amongst younger, more affluent, urban Irish people. The incidence of malignant
melanoma, both invasive and in-situ, is increasing across all age groups. The field of targeted therapies
in management of advanced melanoma is evolving as more drugs are developed to target signalling
pathways. BRAF inhibitors are now available but Irish patients have a lower BRAF mutation rate than is
detected in other populations, which has implications for their application. Immunomodulators such as
ipilimumab and nivolumab may have a significant impact on survival rates in advanced melanoma in a
minority of patients.
There are currently no NCCP designated centres for skin cancer management and no specific NCCP funding
for management of patients with these tumours. An NCCP referral form for suspicious pigmented lesions
was introduced across the country in 2013. There is a “one-stop” see and treat pigmented lesion clinic
every fortnight in dermatology and a joint dermatology/plastic surgery see and treat pigmented lesion
clinic every 3 weeks. Pigmented lesions and other referrals suspicious for cancer are also seen in general
clinics. Patients referred for wide local excision and consideration for sentinel lymph node biopsy are seen
in a weekly surgical clinic which is attended by the melanoma CNS. The referral pathway to oncology is also
established.
In 2014, 1018 patients were diagnosed with basal cell cancer and 505 with squamous cell cancer. Some of
these patients may have had multiple cutaneous tumours treated. Malignant melanoma was diagnosed
in 146 individuals and rarer cutaneous malignancies diagnosed included lymphoma, dermatofibroma
sarcoma protruberens and merkel cell cancer.
In SVUH, there is a fortnightly melanoma MDT which is attended by dermatologists, plastic surgeons,
general breast and endocrine surgeons, medical oncologists, radiation oncologists and histopathologists.
There is a part-time melanoma CNS (shared with lung cancer service). There were 23 MDTs in 2014. The
need for a squamous cell carcinoma MDT is also recognised as patients with high risk tumours often require
a multidisciplinary input from dermatology, plastic surgery, ENT surgery and radiation oncology.
Skin Cancer Diagnosis SVHG
2013
2014
Basal cell carcinoma
1051
1018
469
505
0
7
156
147
Dermatofibroma sarcoma protruberens
2
1
Malignant lymphoma
5
5
Merkel cell tumour
1
5
1684
1688
Squamous cell carcinoma
Squamous cell carcinoma in situ
Malignant melanoma
Grand Total
* Data represented above relate to ‘Unique Patients’, ie. the number of patients treated. Some patients may have been treated
for multiple tumours.
Page 44
Urological Cancers
Introduction
Urological Cancer Services are principally provided on the St Vincent’s University Hospital campus, with St
Michael’s Hospital, Dun Laoghaire and St Columcille’s Hospital, Loughlinstown looking after decreasing numbers
of repeat cases of Prostate Renal and Bladder Cancer, as the majority of activity is moving to the Cancer Centre
in SVUH.
St Charles Ward which relocated to the third floor of the new Nutley building in 2013 is a modern 18 bed (single
room) dedicated Urology Ward which allow us to treat a broad range of both benign and malignant urological
conditions within a specialised framework of dedicated Urology Nurses.
Our multidisciplinary team incorporates Radiologists,Pathologists, Medical and Radiation Oncologists, with the
support of two Clinical Nurse Specialists. We interact extensively with our Interventional Radiology Colleagues in
the management of Renal Obstruction.
We have three weekly Meetings incorporating Uro-Radiology, MDT and Clinical Audit / Journal Club.
We have three full time Consultants in the unit with one further Consultant based 50% of the time in St Vincent’s
University Hospital and 50% in the Mater Hospital. Two Consultants have sessional commitments at St Michael’s
and St Columcille’s Hospitals. The application for a further Consultant post is currently being processed.
All four Consultant Urologists deal with Urological Cancers. There is sub-specialisation within the group in the
areas of Prostate, Renal (laparoscopic), Advanced Renal, Bladder and Reconstruction (Neo bladder formation),
Retroperitoneal lymph node dissection for Testis cancer and Pelvic Exenteration for appropriate colorectal and
gynaecologic cancers.
Mary Nevin, previous CNM2 on St Charles Ward for 12 years, has recently become CNS Urology. She is a welcome
addition to the team.
Page 45
Subsequent to the Annual NCCP meeting at Farmleigh there has been an additional KPI stipulating all
patients ( including non RAPC) who undergo a Trus Biopsy be contacted by phone post-biopsy to check
regarding UTI or Sepsis. This is carried out by the two CNS. This will be helpful in pre-empting serious
sepsis requiring treatment and also providing data to improve infection prevention. Both Radiology and
Microbiology have been liaising with the team regarding this.
There has been a review by Mr David Mulvin of cancer data relating to all RAPC referrals since its inception
in 2010 to the end of 2014. This includes Gleason grading breakdown and patient treatment choices and has
been collated by the CNS and the data manager.
The two CNS continue to provide intra-vesicle bladder cancer treatments on a weekly basis on St Mark’s
Ward.
There have been approximately 600 patients discussed at MDT annually. This is co-ordinated by the two CNS
and our data manager. Public, private and patients from outlying hospitals are discussed with input from
Histopathology, Radiology, Radiation-Oncology and Medical Oncology.
The use of MRI imaging continues to aid diagnosis and surveillance of prostate cancer. The recommendation
of the NCCP is that all patients undergoing active surveillance have an MRI prostate. Once the MRI has been
carried out the report is reviewed by the team and with co-ordination by the two CNS and radiographers
either targeted or standard biopsies are arranged. MRI has also been very helpful for patients who have
rising or unresolving abnormal PSAs with negative Trus Biopsies.
The unit is routinely involved with the inevitable urological complications of gynaecological and colo-rectal
cancer i.e. renal / ureteric obstruction, a urinary fistulae, etc.
We are increasingly aware of the rising numbers of incidentally detected cancers detected in patients being
imaged for non urological conditions and published some initial findings in this area in 2013.
The Urology Unit is designated as one of the six National Cancer Centres of Excellence by the NCCP and with
the Rapid Access Prostate Clinics, of which there are four clinics per week, sees over 300 patients per year.
There has been a significant increase in the volume of patients being treated in St Vincent’s University
Hospital Urology Department over the past five years, especially recently with the incorporation of Ireland
East, with Wexford and Kilkenny Hospitals being formally incorporated into our referral base. If planned
expansion in departmental numbers can be achieved it is hoped to establish some outreach urological
activity most likely based in Kilkenny.
St Vincent’s University Hospital
Total 2013
Total 2014
Total number of Outpatient clinics per week
7
7
Designated Cancer Outpatient clinics per week
3
3
New Patients (Rapid Access Prostate Clinic
309
319
Review Patients (RAPC)
158
182
Total Number of Patients Seen (RAPC)
466
501
Total Diagnosed RAPC (prostate)
109
140
Page 46
RAPC Clinic Activity 2014
350
319
300
250
200
182
150
140
100
50
0
new
return
no. positive
diagnosis
SVUH RAPC treatment choice 2010 to 2014
300
NUMBER
Total
270
250
200
150
147
100
94
50
32
1
0
A/W Decision
31
Brachytherapy
Hormones
6
Radiotherapy
Refused Tx
RRP
Surveillance
TREATMENT
SVUH RAPC 2010 to 2014
1400
Total
1311
1200
TOTAL
1000
800
600
580
400
414
200
0
17
DNA
272
No Biopsy
Referred to RAPC
TRUS Negative
TRUS Positive
NUMBER
Page 47
SVUH RAPC 2010 to 2014 Cancer Type
600
580
NUMBER
500
Total
400
300
200
100
4
0
Acinar
Adenocarcinoma
4
4
10
ASAP
Atypia
PIN
CANCER TYPE
Numbers of new Primary Cancers
Diagnosis
Prostate
Bladder
Kidney
Testicular
Penile
Ureter
Total
Primary Cancer 2013
109
55
46
11
3
224
Primary Cancer 2014
233
80
47
18
5
7
390
Multidisciplinary Meetings
Frequency of MDT Meeting
No. of MDM
No. of Patients Diagnosed with Cancer
Weekly 2013
47
224
Weekly 2014
45
390
Urology Cancers by Tumor Site 2014
250
233
200
150
100
80
50
0
Page 48
32
31
47
1
Prostate
Bladder
Kidney
18
5
7
Testicular
Penile
Ureter
Surgery type: SVUH only
Circumcision
26
Cystoscopy
827
TURBT & Rigid Cystoscopy
33
TURP & Rigid Cystoscopy
22
Ureteroscopy & Cystoscopy
223
Nephrectomy
32
Nephro-Ureterectomy
7
Orchidectomy
19
Penectomy
2
Radical Retropubic Prostatectomy
30
TURBT
23
TURP
30
Ureteroscopy
30
Urology Surgical Procedures 2014 SVUH
1000
827
600
400
19
2
30
23
30
Radical Retropubic Prostatectomy
TURBT
TURP
30
Ureteroscopy
7
Penectomy
TURP & Rigid Cystoscopy
32
Orchidectomy
22
Nephro-Ureterectomy
33
TURBT & Rigid Cystoscopy
Cystoscopy
26
Circumcision
0
Nephrectomy
223
200
Ureteroscopy & Cystoscopy
NUMBER
800
Page 49
Medical Oncology
2014 was another very busy year for the Medical Oncology Department in St Vincent’s University Hospital, with
increasing numbers of patients attending our outpatient clinics and day centre.
There are seven Consultant Medical Oncologists in the Medical Oncology Department, with disease site
specialisation being a key feature (Table 1). Eight consultant-led, disease-oriented oncology outpatient clinics are
held each week. New patients are generally seen within two weeks of referral and the goal is for chemotherapy,
where indicated, to commence within two weeks of the decision to treat in line with the NCCP key performance
indicators. There were over 4,000 medical oncology clinic visits in 2014, including 601 new patient visits. The
total number of clinic visits in 2014 increased by 5% from the preceding year (Table 2).
Table 1: Consultant Medical Oncologists by Site Specialisation
Dr Emer Hanrahan
Lung
Dr Janice Walshe
Breast
Dr David Fennelly
Gynaecology
Gastro-Intestinal
Dr Ray McDermott
Genito-Urinary
Gastro-Intestinal
s.i. Pancreas
Prof John Crown
Dr Giuseppe Gullo
Breast
Melanoma
Dr Alexia Bertuzzi
Sarcoma
Page 50
Head & Neck
Lymphoma
Table 2: Outpatient Clinic Visits
St Vincent’s University Hospital
2013
2014
% Variance
627
601
- 4.1%
Return Patient Visits
4,154
4,439
6.8%
Total
4,781
5,040
5.4%
New Patient Visits
In addition to disease-oriented clinics, each Consultant attends the multidisciplinary meetings relevant to their
interests (Table 3). There is also a Medical Oncology MDT / Radiology conference held weekly to discuss complex
case management.
Table 3: MDT meetings attended
Monday
Tuesday
Wednesday
Thursday
Friday
Lung
Colorectal
Pancreas/
Hepatobiliary
Lymphoma
Liver/NET
Breast
Urology
Gynaecology
Melanoma
Breast
Medical Oncology
Sarcoma
Inpatient care and inpatient chemotherapy is provided in St Anne’s Ward, with 20 dedicated Haematology/
Oncology beds. Outpatient chemotherapy treatments take place through the Haematology/Oncology Day
Ward with 16 infusion chairs. There is also space for evaluation of patients on chemotherapy. Chemotherapy
is prepared by staff in the Aseptic Unit who also develop and revise chemotherapy protocols and treatment
guidelines and provide clinical review of chemotherapy prescriptions. Day ward medical oncology activity
increased in 2014, with 6,738 day ward visits catered for, representing an increase of almost 6% on 2013. The
complexity of these day ward visits is also becoming higher as newer agents with differing toxicity profiles come
on stream. In addition, the total number of treatment items compounded in 2014 shows an increase of 14% from
11,154 items in 2013 to 12,718 items in 2014.
The three Oncology Liaison Nurses are key members of the Oncology team, co–ordinating patient care, and
providing vital support and information for patients and their families. There is also a close relationship between
the disciplines of Medical Oncology, Psycho-Oncology and Palliative Care. A weekly meeting to discuss shared
patients is held with a view to optimising the holistic approach to their illness.
The Medical Oncology Research Department is located in the Clinical Research Centre (CRC). The Department
is funded and administered by the Cancer Clinical Research Trust (CCRT), a registered charity which supports
a dedicated cancer research programme in multiple Dublin-based institutions, including St Vincent’s University
Hospital (SVUH), Dublin City University (DCU) and University College Dublin (UCD). The primary focus of CCRT’s
work is translational research and the provision of clinical trials at SVUH, through affiliations with local, ICORG
and international co-operative groups and the pharmaceutical industry. The funding to support the clinical trial
programme is provided by a Health Research Board grant, remuneration from pharmaceutical industry studies
and a dedicated fundraising programme.
In 2014, the CCRT employed 13 staff members on site, including four clinical research nurses, one scientific
researcher, one research registrar, four data managers and three operations/administrative staff. It was another
successful year with over 230 patients accrued to clinical and translational studies (Table 4). Pharmacy provided
compounding and full accountability for more than 35 oncology research projects in 2014. The conduct of
clinical trials at SVUH allows patient access to novel therapies and also results in savings to the hospital on the
costs of existing standard treatments and investigations. The focus of the group is to continue to expand trial
opportunities across all disease sites in 2015.
Page 51
Table 4: Patient Accrual 2014
Group
Designation
Disease Area
Study Type
Study (Acronym)
Patients Recruited
ICORG
Breast
Clinical Trial
TH vs THL
2
ICORG
Breast
Clinical Trial
NSABP B-47
1
ICORG
Breast
Clinical Trial
SWOG S1007 (step 1)
13
ICORG
Breast
Clinical Trial
SWOG S1007 (step 2)
3
ICORG
Breast
Clinical Trial
TRIO 022 – PALOMA-2
4
ICORG
Breast
Clinical Trial
IBCSG 42-12/BIG 2-12 SNAP study
3
ICORG
Breast
Clinical Trial
KATHERINE/NSABP B0i
5
ICORG
Breast
Translational
Anti-Mullerian Hormone Study
2
ICORG
Breast
Clinical Trial
KAMILLA/ROCHE M028231
6
ICORG
Breast
Translational
CADY
1
ICORG
Breast
Translational
Predictive Biomarker Breast
(cohort1)
10
ICORG
Breast
Translational
CharactHer
0
ICORG
Breast
Clinical Trial
Monaleesa-2
1
ICORG
Breast
Observational
ABC Survey
48
ICORG
Breast
Clinical Trial
MDV3100-11 Enzalutamide study
4
ICORG
Breast
Clinical Trial
MDV3100-12 Enzalutamide study
3
ICORG
Lung
Clinical trial
Novartis LDK378A2303
5
ICORG
Lung
Observational
ETOM-1
89
ICORG
Pancreatic
Translational
PDAC Plasma Biomarkers
1
ICORG
Colon
Clinical Trial
LCCC 1029
1
ICORG
Colon
Clinical Trial
AngioPredict
9
ICORG
Melanoma
Clinical Trial
BMS CA209-067
3
Non-ICORG
Breast
Clinical Trial
BOLERO-6
2
Non-ICORG
Head and Neck
Clinical Trial
BERIL-1
1
Non-ICORG
Pancreatic
Translational
Biomarkers in pancreatic cancer
1
Non-ICORG
Colorectal
Clinical Trial
BMS CA209-142
3
Non-ICORG
Melanoma
Clinical Trial
GSK DESCRIBE
8
Non-ICORG
Melanoma
Clinical Trial
IMAGE CA184-143
3
Non-ICORG
Pancreatic
Clinical Trial
Apact Study
1
TOTAL PATIENT ACCRUAL
233
Page 52
Health and Social Care
Professionals
Overview of Dietetics Services to Cancer Patients
Nutrition has a role to play in cancer prevention, treatment and cancer survivorship. However, due to the acute
nature of services delivered at St Vincent’s University Hospital, Dietetic Services are targeted at those patients
undergoing surgery, chemotherapy and radiotherapy for the treatment of solid tumours and haematological
malignancies.
As the incidence of malnutrition in cancer patients varies from 50% prior to treatment and up to 80% in advanced
cancer, the priority lies in identifying those “at risk” of malnutrition and treating and reversing malnutrition
where possible. The Malnutrition Nutritional Risk Tool (MUST) is used to identify those admitted to hospital or
the Oncology Day Centre who are at nutritional risk. This generates a referral to the Dietitian where a patient is
identified at high risk (score of 2 – 6).
Nutritional intervention is mainly in the form of nutritional support (oral nutritional supplement, enteral or
parenteral feeding). It also includes aggressive management of side-effects of treatment (anorexia, nausea,
vomiting, constipation) using pharmacological and dietary intervention.
Staffing/Workload
There is one WTE senior Dietitian dedicated to Surgical Pancreatic Cancer appointed under NCCP in January
2011. All other Dietitians are assigned by consultant team and provide services to multiple teams.
Page 53
Number
patients
referred
to Dietetic Service between 2012 and 2014
Numberof
of patients
per year
by cancer site
Number of patients per year by cancer site
120
100
80
60
40
20
0
Gynae
Breast
Colorectal
Lung
Pancreas
Prostate
Upper GI
“Other”
2012
Myeloma
Leukaemia
2013
2014
There were equal numbers of referrals for patients between 2013 and 2014. The large number of referrals under
“other” requires further classification which will be added to the Dietetic database.
Research/ Service Improvement Initiatives
The pancreatic cancer Dietitian and Clinical Nurse Specialist have taken part in a collaboration led by National
Cancer Control Programme (NCCP), resulting in the development of a national referral form for pancreatic
cancers, and a resource manual for healthcare staff involved in the care of pancreatic cancer patients nationwide.
These are awaiting presentation at the NCCP Pancreatic Cancer Annual Meeting 2015.
Oonagh Griffin also undertook an audit evaluating patient outcome and nutritional status in collaboration with
surgical colleagues following the introduction of a different pancreatic reconstruction technique post Whipples
Procedure. This was accepted for poster presentation at the Pancreatic Society of Great Britain and Ireland 2014,
and the Irish Society for Clinical Nutrition and Metabolism 2015.
Oonagh has also contributed to the updating of the Irish Cancer Society Pancreatic Cancer patient information
booklet.
Overview of the Oncology / Haematology Social Work Service to Cancer Patients
Oncology/ Haematology Social Work provides Social Work services to patients and their families facing the
impact of a diagnosis of cancer. The scope of Oncology/Haematology Social Work includes clinical practice,
programme planning, education and research.
The Oncology/ Haematology Social Worker in St Vincent’s University Hospital provides psychosocial services to
inpatients, outpatients and day patients all along the disease continuum from initial diagnosis of cancer to end
of life care. These services can include:
Assessment
A central role of the Oncology/Haematology Social Worker is to assess patient and family care needs, and to
provide interventions that help clients to work toward solutions that address their physical, emotional,
interpersonal and environmental problems.
Counselling
The Oncology/Haematology Social Worker provides both individual and family counselling. Interventions are
based on a range of theoretical approaches (cognitive-behavioural, systems, task centred, crisis intervention,
problem solving, brief solution focused, narrative, conflict resolution) to reduce stress, improve coping skills,
and increase patient/family control. This service also includes direct work with children.
Page 54
Discharge Planning
This involves ongoing liaison with the multidisciplinary team, convening and chairing of family meetings,
formulating care/discharge plans in conjunction with patients’/families’ needs and wishes, mobilising
community resources, making applications and arranging for transfer to alternative placements if a patient
cannot return home (i.e. convalescence, rehabilitation, long term care).
Patient/Staff Education:
The Oncology/Haematology Social Worker provides ongoing education to patients and staff in relation to
psychosocial issues affecting Oncology/Haematology patients and the relevant support services available. In
2009 the Oncology/ Haematology Social Workers group produced a website (www.socialworkandcancer.com)
to enable patients to access information in relation to understanding the psychosocial effects of a diagnosis of
cancer and how to improve access to psychosocial support services.
Advocacy
This service involves providing assistance with navigating the complex health system, identifying and reducing
the barriers to recommended care and services.
The Oncology/Haematology Social Worker also has a role in identifying gaps in services to cancer patients
attending St Vincent’s University Hospital and attempting to redress these gaps.
Examples to date
“Care to Drive” came into existence in SVUH in May 2008. Please see the statistics below.
No. of clients
No. of bookings
No. of drivers
No. of km
2008
66
566
119
39,454
2009
98
798
156
31,473
2010
118
938
158
53,136
2011
127
1012
156
67,881
2012
136
1124
168
72,374
2013
135
1098
166
70,606
Since July 2011 the service has been expanded and is now available to Oncology patients attending St James’s;
The Mater; Tallaght; James Connolly; Mid-Western Regional; Limerick ; Sligo General; Letterkenny; Mid-Western
in Sligo; Waterford Regional; Kerry General; Cork University; Mercy in Cork and Galway Hospitals.
A close working relationship has been formed with the Citizens Information Service which, while based in
the community, holds clinics in St Vincent’s University Hospital to ensure that Oncology patients receive
individualised input from the financial advice service.
The Oncology/ Haematology Social Worker is a member of the Irish Cancer Society’s Medical Committee. This
provides an opportunity to advocate for Oncology/Haematology patients attending St Vincent’s University
Hospital, highlighting gaps in services and resources or any other particular difficulties facing cancer patients on
a day-to-day basis.
Staffing/Caseload
There is one Senior Social Worker dedicated to the area of Oncology/Haematology.
Activity Level/ Number of referrals received
Year
Total
2010
2011
2012
2013
475
415
555
427
Page 55
Overview of Physiotherapy Services to Cancer Patients
Physiotherapy is an essential element of our service to cancer patients. The primary goal is to assist the
individual with a diagnosis of cancer to achieve optimal physical functioning within the limits imposed by
the disease process or the treatments. The indication for input from the physiotherapy service is based on an
individual’s diagnosis, clinical signs and symptoms and identified needs. Physiotherapy provides a holistic
approach to meet the needs of the individual thereby optimising their physical functioning to achieve targeted
and realistic goals that will enhance their quality of life.
The physiotherapy services provided to Oncology and Haematology patients at SVUH are delivered by both the
Surgical Respiratory Physiotherapy Service and the Medical Respiratory Physiotherapy Service.
Within the surgical service the physiotherapist will assess and treat all individuals who have major surgical
intervention to treat their cancer. The aim is to reduce the incidence of post-operative pulmonary complications
in the immediate post-operative period, achieve early independent mobilisation and ensure that their physical
limitations are addressed to facilitate discharge. Physiotherapists give specific exercise protocols and advice
following certain types of surgeries e.g. breast surgery. Patients attending pre-assessment clinic for work-up for
pancreatic and liver surgeries are seen by the Senior Physiotherapist in surgical respiratory care. Patients and
their families are educated in the expected mobilisation plan post surgery, the benefits of early mobilisation and
their role in this process. Individualised activity programmes and airway clearance techniques are prescribed
where appropriate to optimise patients’ physical functioning in preparation for the planned surgical procedure.
The Medical Respiratory Physiotherapy Service provides inpatient care to patients located on St Anne’s Ward.
There is a 0.5 Staff Grade Physiotherapist allocated to the care of this ward. Primarily, physiotherapy resources
are focused on managing respiratory complications that these patients may develop and providing ward-based
rehabilitation to facilitate timely hospital discharge.
In addition to the service on St Anne’s Ward, oncology and haematology patients are cared for by the
physiotherapist providing care to the particular ward. In particular, the physiotherapist is skilled in providing
appropriate patient-specific exercise programmes that can help alleviate cancer-related fatigue and improve
quality of life (NCCN 2006), which is integral to effective management and care of these patients. Physiotherapists
are also skilled to care for palliative patients, especially with patients who are breathless or need assistance to
clear pulmonary secretions which improves patient comfort. Palliative care may also include rehabilitation and
the physiotherapist enables patients to set and achieve realistic goals to maximise independence.
Overview of Speech and Language Therapy (SLT) Service to Cancer Patients
To deliver a high quality patient-centred, evidence based speech and language therapy service evolving around
the assessment, diagnosis and management of swallowing and communication disorders associated with
lung cancer, head & neck (post surgery and/or radiotherapy/chemotherapy), brain tumors and other cancers
including palliative care. These patients may experience a variety of voice, swallowing, language (dysphasia),
and cognitive-linguistic disorders.
Access to service
SLT provide a service to both inpatients and outpatients. The service may take place at the bedside or in the
Speech and Language Therapy Department. Patients may also be seen in their home or nursing home as part of
the new community liaison service.
Swallowing Service
Clinical swallowing assessment
Objective assessments if recommended – FEES (Fiber-optic Endoscopic Evaluation of Swallowing)
conducted jointly with a member of ENT team and/or Digital Fluoroscopy completed in conjunction with
Professor D.Malone. The SLT Department run two weekly Digital Fluoroscopy clinics.
Ongoing management through accurate diagnosis, diet modification, compensatory strategies, patient and
carer education etc.
Page 56
Voice, Head and Neck Service
This forms part of our ENT service. The SLT Department runs three weekly voice clinics with Mr Russell, Mr
Charles and Prof Curran (Head and Neck).
Patients who present with voice problems will have an objective assessment of the structure and function of
their vocal cords using a digital stroboscopy and a clinical voice assessment.
Ongoing management through vocal tract care, voice conservation, patient and carer education,
compensation strategies and augmentative communication aids (voice amplifier), tracheotomy
management, speaking valves, voice prosthesis, etc.
Language and Cognitive – Linguistic Service
Complete language(auditory comprehension, expressive language, reading and writing) and cognitive –
linguistic(memory, problem solving ,reasoning) assessments.
Ongoing management through therapy programmes etc.
Augmentative and alternative communication devices.
Family and carer education.
Psycho-oncology
Psycho-oncology is a specialist service with a clinical, teaching and research remit to cancer services following
internationally recognised standards of best practice. It provides this service across the cancer trajectory: from
diagnosis to the curative, palliative and end-of-life care of cancer patients at St Vincent’s University Hospital. The psychological care of patients experiencing cancer is considered an integral part of quality cancer care
(Holland & Alici, 2010), with research suggesting that up to half of cancer patients will report distress (National
Cancer Institute, 2013) and up to a third will warrant referral to a psycho-oncology service (Carlson and Bultz,
2003). Early evaluation and screening leads to early and timely management of psychological distress, which in
addition aids medical management and resource allocation in hospital settings (Carlson & Bultz, 2003; Holland
& Alici, 2010) while failure to recognise and treat distress leads to problems such as difficulty in making decisions
about and adhering to treatment, additional physician visits and greater time and stress for the oncology team
(NCCN, 2010). International guidelines indicate that psychological services should be part of routine care of
oncology patients (Institute of Medicine, 2007; NICE, 2004) and routine assessment of psychological distress
among cancer patients is now accepted as minimum standard practice.
This report details the staffing, activity levels, on-going development and educational output of the Psychooncology Department at St Vincent’s University Hospital for 2014, which continues to adhere to the international
guidelines and standards of best practice and quality of care for cancer patients.
Staffing
Dr Paul D’Alton, Senior Clinical Psychologist, Head of Psycho-oncology Department
Ms Mary Moriarty, Clinical Nurse Manager 2 / Complementary Therapist (1 WTE)
Dr Louise Kinsella, Clinical Psychologist (0.1 WTE)
Sessional Psychologist (0.1 WTE)
HSE Funded Psychologists in Clinical Training (varied placements)
Ms Caroline Livingstone, Administrator
Activity levels
The Psycho-oncology Department provided 4,450 episodes of care (i.e. inpatient or OPD screening /assessment,
OPD therapy). Averaged waiting time for OPD assessment in 2014 was 15 working days. The majority of inpatient
consultations were seen within 48 hours. As per previous years, patients with breast cancer represent the largest
group attending the service, followed by patients with lung cancer.
Page 57
The on-going development of Psycho-oncology at SVUH
Psycho-oncology at St Vincent’s University Hospital continues to focus on early identification, assessment
and support of patients during the acute phase of their illness and the provision of time-limited outpatient
psychotherapy services. As noted in 2013, a multidisciplinary Psycho-Oncology service should involve
Psychology, Psychiatry, Nursing and Social Work according to international guidelines (UK NICE Guideline:
Improving Supportive and Palliative Care for Adults with Cancer; Pan-Canadian Clinical Practice Guideline:
Assessment of Psychosocial Health Care Needs of the Adult Cancer Patient). The continuing deficit in the SVUH
Psycho-oncology service is the absence of dedicated Liaison Psychiatry input and sessions from a Consultant
Psychiatrist is a major issue for patient care.
Education
On October 17th 2014, members of the Department hosted a Psycho-Oncology Study Day in the Education and
Research Centre at St Vincent’s University Hospital. The day was attended by delegates from multiple disciplines
including doctors, nurses, hospice and palliative care practitioners, as well as students.
The Head of the Department, Dr Paul D’Alton, gave a Public Information Talk entitled ‘Why Being Positive Can
Be Bad For You’ for Europa Donna Ireland – The Irish Breast Cancer Campaign, at The Central Hotel, Exchequer
Street, Dublin 2, October 13th 2014.
Throughout the year the Department also provides supervised placements for Psychologists in Clinical Training
from universities in Ireland, and members of the team have continued to provide external input to university
training programmes for multiple disciplines including Psychology and Nursing.
Page 58
The Irish Cancer Society
Daffodil Centre at St
Vincent’s University
Hospital
The Daffodil Centre aims to provide a wide range of in-person information to anyone affected by or concerned
about cancer and to help them cope with the impact cancer is having on their lives. The Centre is managed
by a nurse with specialist cancer experience, and trained volunteers who provide practical information and
emotional support, and accompany people to appointments or treatment as necessary. The Daffodil Centre
is open daily to everyone from 08.30-16.30 and no referral or appointment is necessary – cancer patients
(inpatients and outpatients), family members, hospital staff and the general public are all welcome. There are
currently 13 Daffodil Centres around the country and in 2014, they dealt with queries from over 44,000 people.
St Vincent’s University Daffodil Centre dealt with 1,434 enquirers to the centre and 1571 browsers. Staff are
trained to listen, and to provide information and advice in clear and easy-to-understand language.
Page 59
11%
664
46%
Undiagnosed with symptoms
Enquirer with questions about lifestyle/cancer prevention
Relative/friend of a diagnosed person
483
The types of
queries dealt with at Daffodil Centres cover
all types of cancer and all types of treatments and
30%
Diagnosed
services available, including:
Tests and investigations to diagnose cancer
Cancer prevention and health promotion
Screening and early detection of cancer
19
11
1% including
1 % surgery, radiotherapy, chemotherapy, hormone therapy and new therapies
Cancer treatment
Side effects of treatments
89
Emotional support
through listening
7%
134
Local cancer
support services
10%
End-of-life services
Dublin
Wicklow
Life after cancer treatment
Financial and practical supports
Participation in clinical trials
1069
81%
Wexford
Kildare
Laois
The pie chart below shows the top 5 cancers that the Daffodil Centre dealt with in 2014.
Type of Primary Cancer - Top 5
70
11%
46
7%
Breast
Lung
79
12%
Bowel (colon and rectum)
365
57%
84
13%
Prostate
Ovarian
Enquirer Activity
456enquirers and Daffodil Centre activityEmotional
Information on
gathered
from the Enquirer Record Forms February to
support
December 2014.
877
Total number of enquirers: 1434
Cancer treatments and side effects
1030 471
(72%) Enquiries were handled by a Cancer Information
Service
Nurse health services
Hospital
and community
404 (28%) By a Daffodil Centre Volunteer
1571 Browsers to the Daffodil Centre
641
621
620 People attended
Awareness
Stands
Irish Cancer Society services
Tests and investigations
1150 (80%) were first time enquirers to the Daffodil Centre
284 (20%) had visited before
92 (6%) Enquirers worked within the hospital
127
3%
98
113 2%
2%
Page 60
220
5%
180
4%
23 20 3
1% 0% 0%
3
0%
Verbally
Information booklet/leaflet
Listening/emotional support
St Vincent’s
Healthcare
Referred to services
within
hospital Group Cancer Annual Report 2014
Time spent on enquiry
20%
35%
17%
15%
9%
4%
Less than 5 minutes
10 minutes
15 minutes
20 minutes
30 minutes
40+ minutes
MALE
404
28%
Gender
Most enquirers were female (72%)
FEMALE
1030
72%
Age Groups
The majority of enquirers (43%) were in the 40-59 age group, with 39%
in the 60-79 age bracket.
28
2%
18
1%
36
2%
56
4%
208
15%
Healthcare Professional
152
11%
40-59 yrs
555
39%
Undiagnosed with worries/
95
7%
20-39 yrs
664
46%
60-79 yrs
80 yrs +
614
43%
MALE
404
28%
Diagnosed
19
1%
FEMALE
11
1%
89
7%
1030
Type
of Enquirer
72%
134
10%
76% of enquirers were people with cancer or their family and friends.
Dublin
4% of enquirers were Healthcare professional within the hospital seeking information on behalf of
their patients/clients.
Wicklow
Wexford
Kildare
11% of enquirers were seeking information on lifestyle/cancer prevention.
1069
81%
Laois
36
2%
56
4%
Undiagnosed with worries/concerns (no symptoms)
95
7%
152
11%
664
46%
46
7%
70
11%
Breast
Lung
79
Enquirer with questions about lifestyle/cancer
prevention
Bowel (colon and rectu
12%
483
30%
365
57%
84
13%
Diagnosed
19
1%
Prostate
Ovarian
11
1%
456
89
7%
Dublin
Emotional support
877
134
10%
Enquirer with questions ab
Relative/friend of a diagno
483
30%
Not recorded on paper form
Undiagnosed with sympto
471
Page 61
Cancer treatments and
152
11%
664
46%
Enquirer with questions about lifestyle/cancer prevention
Counties
483
Enquirers30%
visit the Daffodil Centre from all over Ireland but most enquirers came from Dublin (81%),
Diagnosed
Wicklow and Wexford.
Geographical Spread of Enquirers - Top 5
19
1%
11
1%
89
7%
134
10%
Dublin
Wicklow
Wexford
Kildare
1069
81%
Laois
How Enquirers
found out about the Daffodil Centre
46
7%found the centre by seeing the signs, posters or leaflets.
81% who visited
Breast
70
11%
2% by attending
an Awareness Stand
Lung
Healthcare Professionals within St Vincent’s University referred 8% of enquirers to the Daffodil Centre and
79
7% 12%
heard about the Daffodil Centre by word of mouth.
11 8
1% 1%
2184
13%
2%
365
3
0 % 57%
88
7%
90
8%
Prostate
1069
81%
Ovarian
Saw signs, posters or leaflets
Referred by a Healthcare Professional in this Hospital
Word of Mouth
Awareness Stand
456
924
81% 877
471
Emotional
support
Irish Cancer
Society
- National Cancer Helpline/website
Referred
by atreatments
Healthcareand
Professional
in another
Cancer
side effects
hospital or in the community
Hospital
andDaffodil
community
Heard
about the
Centrehealth
from aservices
local cancer
support service/group
641
621
127
3%
98
113 2%
2%
220
5%
246 62
Page
5%
23 20 3
1% 0% 0%
3
0%
Verbally
180
4%
Referred to services within hospital
1,415
30%
Referred to a cancer support centre/group
Referred to services within community
11%
Lung
79
12%
Subject84of Enquiry
365
57%
Prostate
13% have a number of questions to ask when
Ovarian
Most enquirers
they visit. Most enquiries have an element of
emotional support and both the nurses and volunteers provide emotional support through listening and
signposting to services within the hospital and other relevant organisations.
Subject of Enquiry - Top 5
456
Emotional support
877
471
Hospital and community health services
641
621
Emotional support
877
61%
Cancer treatments
and 3side effects
23 20
641
45%
621
43%
98
1% 0% 0%
3 services
Hospital
2% community health
113 and
0%
Verbally
Irish
127 Cancer Society services
471
33%
Listening/emotional
support
456
32%
2%
3%
180
4%
Local cancer
support
220
5% Prevention
Cancer
246
5%
Symptoms
services
and warning signs
within hospital
421
30%
1,415
30%
Referred to a cancer
support centre/group
399
28%
within community
338
23%
Referred to other Irish
Talking
about cancer:personal/family, children & friends
305Cancer Society
21% services
376
8%
Referred to Daffodil
Centre Cancer
Information Service Nurse
Practical
support and advice (equipment/childcare/travel)
158
11%
Life after cancer/survivorship
Referred to GP
155
11%
Causes of875
cancer/risk factors
Internet
151
10%
146
10%
137
9%
99
7%
89
6%
End of life issues
77
5%
Bereavement
42
3%
Pre cancerous conditions
9
1%
18%
Financial/entitlements
1067
22%
Prognosis
Family history/inherited cancer risk
Recurrence
Written
Referred to Irish Cancer Society Survivorship programme
Accompany enquirer to clinic/clinical area
Forwarded a complex enquiry to the Irish Cancer Society
Page 63
Kildare
1069
81%
Laois
Type of Primary Cancer - Top 5
70
11%
46
7%
Breast
Lung
79
12%
84
13%
365
57%
Prostate
Ovarian
Acute lymphoblastic leukaemia (ALL)
Acute myeloid leukaemia (AML)
Anal
Emotional support
Bile Duct 456
Bladder
877
Bone
471(colon and rectum)
Bowel
Hospital and community health services
Brain (all types of primary brain tumours such as gliomas, oligodendrogliomas, astrocytomas etc)
Breast
Cervical
641 (CLL)
Chronic lymphocytic
leukaemia
621
Chronic myeloid leukaemia (CML)
Endocrine tumours
Eye (including ocular melanoma)
Gall bladder
Head & neck cancers (mouth, tongue, tonsil, nasopharynx, nasal or paranasal sinus cancer)
Hodgkin’s lymphoma
Kidney (renal call)
23 20 3
1% 0% 0%
98
3
Larynx 2%
Verbally
113
0%
2%
Liver
127
3%
Lung
Melanoma
180
4%
Myelodysplastic
Syndromes(MDS)
220
5%
1,415
Myeloma (sometimes called multiple
myeloma) Referred to a cancer support centre/group
246
30%
5% of cancer not known
Name
Referred
other Irish Cancer Societytumours)
services
Neuroendocrine tumours (including carcinoid tumours
andto
gastroenteropancreatic
376
8%
Non-Hodgkin’s
lymphoma
Referred to Daffodil Centre Cancer Information Service Nurse
Oesophageal (gullet)
Referred to GP
Other
Internet
Ovarian 875
1067
Written
18%
22%
Pancreatic
Penile
Prostate
Skin (basal cell skin cancer and squamous cell skin cancer)
Soft tissue sarcomas
Stomach
Testicular
Thyroid
Unknown primary
Womb (uterine, endometrial or lining of the womb)
Page 64
5
11
3
4
11
3
79
17
365
3
16
2
2
2
3
10
10
13
4
28
84
21
1
36
12
16
40
18
11
46
27
1
70
13
15
12
15
7
17
7
Dealing with Enquiries
The nurse and volunteers provide information and support that is tailored to an enquirer’s needs whether that
entails - talking through a question, giving an information leaflet, finding information for the enquirer online and
directing them to reliable cancer information websites.
The top 5 ways enquiries were dealt with:
Verbally
How was the query dealt with?
Verbally
1,415
99%
1067
74%
875
61%
376
26%
246
17%
220
15%
Referred to other Irish Cancer Society services
180
12%
127
9%
Referred to GP
113
8%
Internet
98
7%
Written
23
2%
20
1%
7
0.4%
3
0.2%
Page 65
641
621
Enquiries were dealt with in the following way
127
3%
98
113 2%
2%
220
5%
23 20 3
1% 0% 0%
3
0%
Verbally
180
4%
1,415
30%
246
5%
Referred to other Irish Cancer Society services
376
8%
Referred to GP
875
18%
Internet
1067
22%
Written
Please state location of consultation if not in a Daffodil Centre
10
Awareness Stand
Outpatients
2
Ward
3
Other
2
The Centre is manned by a Cancer Information Service (CIS) Nurse Fiona Walsh who works 8.30am to
4.30pm, Monday – Friday
There were 18 (1 on sabbatical) active volunteers
Each volunteer attended for three hours per week in the centre 10am – 2pm or 1pm – 4.30pm. Some have
less availability during the summer months due to holidays etc. They will often have extra availability upon
request.
Other Service Activity
Continuing Professional Development/Education & Seminars:
Attended Irish Association of Nurses in Oncology Meeting March.
Attended Neuro-Oncology Conference at Beaumont Hospital May.
Attended Imuno-Oncology Masterclass and Experience Sharing evening June.
Attended ASCO Highlights evening June.
Attended Targeted Therapies Educational Day in SVUH June.
Partook in Pancreatic Expert Panel Meeting in the ICS, also attended by CNS and dietician from SVUH.
Completed Psycho-Oncology Study Day in SVUH October.
Attended Young Women and Breast cancer Conference in UCD October.
Attend guided supervision regularly in the ICS head office.
Accessed relevant medical oncology/haematology and nursing journals regularly on line.
Regularly attend oncology and haematology journal club meetings here in SVUH.
Page 66
Cancer Awareness/Early Detection Information Stands
Attendees
St Anne’s Weekly Awareness Stand (when possible)
355
Sun Smart Awareness Stands
135
Men’s Health
56
Breast Clinic Stand
8
Pancreatic Clinic Stand
1
Bowel Cancer
41
Training
Completed Orientation to hospital and Daffodil Centre for all volunteers.
SVUH Corporate Induction attended by Fiona, which includes manual handling, CPR, fire safety
training, etc.
ICS Volunteer training completed by all volunteers
SVUH Manual Handling and Fire Safety completed by all volunteers
Fiona has a volunteer awareness folder in the centre to educate the volunteers and before each
campaign she reviews this with each volunteer.
Fiona completed a volunteer training day in the ICS run by Volunteer Ireland.
Promotion
Attended various MDTs
Met individually with specialist nurses and specialist teams such as Psycho-Oncology, Palliative Care,
Breast Care Nurses etc.
Visited Breast Check on site.
Presented at nurse education day in SVUH in May.
Presented the role of the Daffodil Centre and statistics at NCE meeting in July.
Presented the role of the Daffodil Centre at Health Care Assistant Education Day in August.
Daffodil Centre pull up advertisement stand always outside the centre angled in the direction of the
main entrance to draw people from the main corridor.
Daffodil Centre leaflets and posters on all public notice boards, in outpatient’s departments, in St
Anne’s day centre and may other wards within the hospital.
Awareness stands on a weekly basis at St Anne’s (when volunteers are available)
Visited cancer support centres: ARC (South Circular Road), Purple House Cancer Support (formerly
known as Bray Cancer Support) and Greystones Cancer Support. Constantly maintain contact with
these centres and others.
Daffodil Centre article included in Healthwise June edition, included information about the centre
and information on bowel and skin cancer risk.
Daffodil Centre included on SVUH public website.
Other Activities:
In October we worked with the Health Promotion team and presented over two days at the schools seminar.
Over 400 students attended and discussed health awareness and cancer prevention under the heading,
Cancer Awareness- The Future is in your Hands.
The ICS Grants Administrator presented to St Anne’s staff and updated them on ICS and NCCP initiatives.
Care to Drive, Financial Aid Grant, Travel to Care. Subsequently a poster produced by the ICS and NCCP
outlining the Travel to Care criteria as a need for same was recognised at this meeting. This poster was
circulated to CNM’s and CNS’ in oncology and haematology care in SVUH.
One of our volunteers assists every Monday afternoon at the Rapid Access Lung Clinic, walking patients to
and from phlebotomy and x-ray department etc. from 14.45-1600. Both the staff and the volunteer find this
rewarding.
Page 67
Page 68
Publications
Breast
Madden SF, Clarke C, Stordal B, Carey MS, Broaddus R, Gallagher WM, Crown J, Mills GB, Hennessy BT. OvMark: a
user-friendly system for the identification of prognostic biomarkers in publically available ovarian cancer gene
expression datasets. Mol Cancer. 2014 Oct 24;13:241. doi: 10.1186/1476-4598-13-241. PubMed PMID: 25344116;
PubMed Central PMCID: PMC4219121.
Gaule PB, Crown J, O’Donovan N, Duffy MJ. cMET in triple-negative breast cancer: is it a therapeutic
target for this subset of breast cancer patients? Expert Opin Ther Targets. 2014 Sep;18(9):999-1009. doi:
10.1517/14728222.2014.938050. Epub 2014 Aug 1. Review. PubMed PMID: 25084805.
O’Leary PC, Terrile M, Bajor M, Gaj P, Hennessy BT, Mills GB, Zagozdzon A, O’Connor DP, Brennan DJ, Connor
K, Li J, Gonzalez-Angulo AM, Sun HD, Pu JX, Pontén F, Uhlén M, Jirström K, Nowis DA, Crown JP, Zagozdzon R,
Gallagher WM. Peroxiredoxin-1 protects estrogen receptor α from oxidative stress-induced suppression and
is a protein biomarker of favorable prognosis in breast cancer. Breast Cancer Res. 2014 Jul 10;16(4):R79. doi:
10.1186/bcr3691. PubMed PMID: 25011585; PubMed Central PMCID: PMC4226972.
McDermott MS, Browne BC, Conlon NT, O’Brien NA, Slamon DJ, Henry M, Meleady P, Clynes M, Dowling P, Crown
J, O’Donovan N. PP2A inhibition overcomes acquired resistance to HER2 targeted therapy. Mol Cancer. 2014 Jun
24;13:157. doi:10.1186/1476-4598-13-157. PubMed PMID: 24958351; PubMed Central PMCID: PMC4230643.
Rani S, Corcoran C, Shiels L, Germano S, Breslin S, Madden S, McDermott MS, Browne BC, O’Donovan N, Crown
J, Gogarty M, Byrne AT, O’Driscoll L. Neuromedin U: a candidate biomarker and therapeutic target to predict
and overcome resistance to HER-tyrosine kinase inhibitors. Cancer Res. 2014 Jul 15;74(14):3821-33. doi:
10.1158/0008-5472.CAN-13-2053. Epub 2014 May 29. PubMed PMID: 24876102.
Corcoran C, Rani S, Breslin S, Gogarty M, Ghobrial IM, Crown J, O’Driscoll L. miR-630 targets IGF1R to regulate
response to HER-targeting drugs and overall cancer cell progression in HER2 over-expressing breast cancer. Mol
Cancer. 2014 Mar 24;13:71. doi: 10.1186/1476-4598-13-71. PubMed PMID: 24655723; PubMed Central PMCID:
PMC4234346.
McDermott M, Eustace AJ, Busschots S, Breen L, Crown J, Clynes M, O’Donovan N, Stordal B. In vitro
Development of Chemotherapy and Targeted Therapy Drug-Resistant Cancer Cell Lines: A Practical Guide with
Case Studies. Front Oncol. 2014 Mar 6;4:40. doi: 10.3389/fonc.2014.00040. eCollection 2014. PubMed PMID:
24639951; PubMed Central PMCID: PMC3944788.
Duffy MJ, Crown J. Precision treatment for cancer: role of prognostic and predictive markers. Crit Rev Clin Lab
Sci. 2014 Feb;51(1):30-45. doi:10.3109/10408363.2013.865700. Epub 2014 Jan 16. Review. Erratum in: Crit Rev
Clin Lab Sci. 2014 Aug;51(4):248. PubMed PMID: 24432844.
Candon D, Healy J, Crown J. Modelling the cost-effectiveness of adjuvant lapatinib for early-stage breast cancer.
Acta Oncol. 2014 Feb;53(2):201-8. doi:10.3109/0284186X.2013.840740.
Duffy MJ, Crown J, Mullooly M. ADAM10 and ADAM17: New players in trastuzumab tesistance. Oncotarget. 2014
Nov 30;5(22):10963-4. No abstract available. PMID:25460503Research/Publications.
New players in trastuzumabtesistance. Oncotarget. Duffy MJ, Crown J, Mullooly M. ADAM10 and ADAM172014 Nov
30;5(22):10963-4.
OvMark: a user-friendly system for the identification of prognostic biomarkers in publically available ovarian cancer
gene expression datasets;Madden SF, Clarke C, Stordal B, Carey MS, Broaddus R, Gallagher WM, Crown J,Mills GB,
Hennessy BT Mol Cancer. 2014 Oct 24;13:241.
MET in triple-negative breast cancer: is it a therapeutic target for this subset of breast cancer patients? Gaule PB,
Crown J, O’Donovan N, Duffy MJ Expert Opin Ther Targets. 2014 Sep;18(9):999-1009.
Peroxiredoxin-1 protects estrogen receptor α from oxidative stress-inducedsuppression and is a protein biomarker of
favorable prognosis in breast cancer.O’Leary PC, Terrile M, Bajor M, Gaj P, Hennessy BT, Mills GB, Zagozdzon A,
O’Connor DP, Brennan DJ, Connor K, Li J, Gonzalez-Angulo AM, Sun HD, Pu JX, Pontén F, Uhlén M, Jirström K, Nowis
DA, Crown JP, Zagozdzon R, Gallagher WM. Breast Cancer Res. 2014 Jul 10;16(4):R79.
PP2A inhibition overcomes acquired resistance to HER2 targeted therapy. McDermott MS, Browne BC, Conlon NT,
O’Brien NA, Slamon DJ, Henry M, Meleady P, Clynes M, Dowling P, Crown J, O’Donovan N Mol Cancer. 2014 Jun
24;13:157. doi: 10.1186/1476-4598-13-157.
Page 69
Neuromedin U:a candidate biomarker and therapeutic target to predict and overcome resistanceto HER-tyrosine
kinase inhibitors. Rani S, Corcoran C, Shiels L, Germano S, Breslin S, Madden S, McDermott MS, Browne BC,
O’Donovan N, Crown J, Gogarty M, Byrne AT, O’Driscoll L. Cancer Res. 2014 Jul 15;74(14):3821-33.
miR-630 targets IGF1R to regulate response to HER-targeting drugs and overall cancer cell progression in HER2 overexpressing breast cancer. Corcoran C, Rani S, Breslin S, Gogarty M, Ghobrial IM, Crown J, O’Driscoll L. Mol Cancer. 2014
Mar 24;13:71.
In vitro Development of Chemotherapy and Targeted Therapy Drug-Resistant Cancer Cell Lines: A Practical Guide with
Case Studies. McDermott M, Eustace AJ, Busschots S, Breen L, Crown J, Clynes M, O’Donovan N, Stordal B Front Oncol.
2014 Mar 6;4:40.
Precision treatment for cancer: role of prognostic and predictive markers. Duffy MJ, Crown J Crit Rev Clin Lab Sci.
2014 Feb;51(1):30-45.
Modelling the cost-effectiveness of adjuvant lapatinib for early-stage breast cancer. Acta Oncol. Candon D, Healy J,
Crown J 2014 Feb;53(2):201-8.
The Value of Isosulfan Blue Dye in Addition to Isotope Scanning in the Identification of the Sentinel Lymph Node
in Breast Cancer Patients With a Positive Lymphoscintigraphy: A Randomized Controlled Trial (ISRCTN98849733).
OʼReilly EA, Prichard RS, Al Azawi D, Aucharaz N, Kelly G, Evoy D, Geraghty J, Rothwell J, OʼDoherty A, Quinn C, Skehan
SJ, McDermott EW. Ann Surg. 2015 Mar 27. [Epub ahead of print] PMID: 25822674
A comparison of clinical-pathological characteristics between symptomatic and interval breast cancer.
Meshkat B, Prichard RS, Al-Hilli Z, Bass GA, Quinn C, O’Doherty A, Rothwell J, Geraghty J, Evoy D, McDermott
EW.Breast. 2015 Jun;24(3):278-82.
Axillary nodal burden in primary breast cancer patients with positive pre-operative ultrasound guided fine needle
aspiration cytology: management in the era of ACOSOG Z011. Boland MR, Prichard RS, Daskalova I, Lowery AJ, Evoy D,
Geraghty J, Rothwell J, Quinn CM, O’Doherty A, McDermott EW. Eur J Surg Oncol. 2015 Apr;41(4):559-65.
Postmastectomy radiotherapy: indications and implications. Walsh SM, Lowery AJ, Prichard RS, McDermott EW, Evoy
D, Geraghty J. Surgeon. 2014 Dec;12(6):310-5.
ADAM8 expression in invasive breast cancer promotes tumor dissemination and metastasis. Romagnoli M, Mineva
ND, Polmear M, Conrad C, Srinivasan S, Loussouarn D, Barillé-Nion S, Georgakoudi I, Dagg Á, McDermott EW, Duffy MJ,
McGowan PM, Schlomann U, Parsons M, Bartsch JW, Sonenshein GE. EMBO Mol Med. 2014 Feb;6(2):278-94.
Final 10-year results of the Breast International Group 2-98 phase III trial and the role of Ki67 in predicting benefit of
adjuvant docetaxel in patients with oestrogen receptor positive breast cancer. Sonnenblick A, Francis PA, Azim HA
Jr, de Azambuja E, Nordenskjöld B, Gutiérez J, Quinaux E, Mastropasqua MG, Ameye L, Anderson M, Lluch A, Gnant
M, Goldhirsch A, Di Leo A, Barnadas A, Cortes-Funes H, Piccart M, Crown J. Eur J Cancer. 2015 Jun 11. pii: S09598049(15)00285-3.
Targeting ADAM-17 with an inhibitory monoclonal antibody has antitumour effects in triple-negative breast cancer
cells. Caiazza F, McGowan PM, Mullooly M, Murray A, Synnott N, O’Donovan N, Flanagan L, Tape CJ, Murphy G, Crown
J, Duffy MJ. Br J Cancer. 2015 Jun 9;112(12):1895-903.
PTEN Loss Is Associated with Worse Outcome in HER2-Amplified Breast Cancer Patients but Is Not Associated with
Trastuzumab Resistance. Stern HM, Gardner H, Burzykowski T, Elatre W, O’Brien C, Lackner MR, Pestano GA, Santiago
A, Villalobos I, Eiermann W, Pienkowski T, Martin M, Robert N, Crown J, Nuciforo P, Bee V, Mackey J, Slamon DJ, Press
MF. Clin Cancer Res. 2015 May 1;21(9):2065-74.
Phase II, multicenter, open-label, randomized study of YM155 plus docetaxel as first-line treatment in patients with
HER2-negative metastatic breast cancer. Clemens MR, Gladkov OA, Gartner E, Vladimirov V, Crown J, Steinberg J, Jie F,
Keating A. Breast Cancer Res Treat. 2015 Jan;149(1):171-9.
HER2-family signalling mechanisms, clinical implications and targeting in breast cancer. Elster N, Collins DM, Toomey
S, Crown J, Eustace AJ, Hennessy BT. Breast Cancer Res Treat. 2015 Jan;149(1):5-15.
The cyclin-dependent kinase 4/6 inhibitor palbociclib in combination with letrozole versus letrozole alone as
first-line treatment of oestrogen receptor-positive, HER2-negative, advanced breast cancer (PALOMA-1/TRIO-18):
a randomised phase 2 study. Finn RS, Crown JP, Lang I, Boer K, Bondarenko IM, Kulyk SO, Ettl J, Patel R, Pinter T,
Schmidt M, Shparyk Y, Thummala AR, Voytko NL, Fowst C, Huang X, Kim ST, Randolph S, Slamon DJ. Lancet Oncol.
2015 Jan;16(1):25-35.
ADAM10 and ADAM17: New players in trastuzumab tesistance. Duffy MJ, Crown J, Mullooly M. Oncotarget. 2014 Nov
30;5(22):10963-4.
Page 70
Colorectal
Prognostic significance of tumor budding in rectal cancer biopsies before neoadjuvant therapy. Rogers AC, Gibbons D,
Hanly AM, Hyland JM, O’Connell PR, Winter DC, Sheahan K. Mod Pathol. 2014;27(1):156-62.
Management of colorectal cancer in patients with inflammatory bowel disease. Kavanagh DO, Carter MC, Keegan D,
Doherty G, Smith MJ, Hyland JM, Mulcahy H, Sheahan K, O’ Connell PR, O’ Donoghue DP, Winter DC. Tech Coloproctol.
2014;18(1):23-8
BRAF mutations in melanoma and colorectal cancer: a single oncogenic mutation with different tumour phenotypes
and clinical implications. Sclafani F, Gullo G, Sheahan K, Crown J. Crit Rev Oncol Hematol. 2013;87(1):55-68.
Effects of radiation on levels of DNA damage in normal non-adjacent mucosa from colorectal cancer cases. Sheridan
J, Tosetto M, Gorman J, O’Donoghue D, Sheahan K, Hyland J, Mulcahy H, Gibbons D, O’Sullivan J. J Gastrointest
Cancer. 2013;44(1):41-5.
Omental pedicle flaps following proctectomy: a systematic review. Killeen S, Devaney A, Mannion M, Martin ST, Winter
DC. Colorectal Dis. 2013;15(11):e634-45
Multivisceral resection in colorectal cancer: a systematic review. Mohan HM, Evans MD, Larkin JO, Beynon J, Winter
DC. Ann Surg Oncol. 2013;20(9):2929-36
Prognostic significance of detection of microscopic peritoneal disease in colorectal cancer: a systematic review.
Mohan HM, O’Connor DB, O’Riordan JM, Winter DC. Surg Oncol. 2013; 22(2):e1-6
A comparative study of short- and medium-term outcomes comparing emergent surgery and stenting as a bridge to
surgery in patients with acute malignant colonic obstruction.
Kavanagh DO, Nolan B, Judge C, Hyland JM, Mulcahy HE, O’Connell PR, Winter DC, Doherty GA. Dis Colon Rectum.
2013;56(4):433-40.
Pancreatic
Neoadjuvant chemoradiotherapy followed by liver transplantation for unresectable cholangiocarcinoma: a singlecentre national experience. Duignan S, Maguire D, Ravichand CS, Geoghegan J, Hoti E, Fennelly D, Armstrong J, Rock
K, Mohan H, Traynor O. HPB 2014;Jan 2014:16;91-8.
Incidence and risk factors of delirium in patients post pancreaticoduodenectomy .Gallagher TK, McErlean S, O’Farrell
A, Hoti E, Maguire D, Traynor OJ, Conlon KC, Geoghegan JG. HPB (Oxford). 2014 Apr 18.
Pancreatectomy for metastatic disease: a systematic review. Adler H, Redmond CE, Heneghan HM, Swan N, Maguire D,
Traynor O, Hoti E, Geoghegan JG, Conlon KC. Eur J Surg Oncol. 2014 Apr;40(4):379-86.
Techniques and outcomes of combined inferior vena cava and visceral resection for benign and malignant disease.
Gallagher TK, Udupa KV, Geoghegan JG, Maguire D, Traynor OJ, Hoti E. Int J Surg. 2014;12(8):864-7.
Radical resection of a late-relapsed testicular germ cell tumour: hepatectomy, cavotomy, and thrombectomy. Ní
Leidhin C1, Redmond CE1, Cahalane AM1, Heneghan HM1, Motyer R1, Ryan ER1, Hoti E1. Case Rep Surg 2014
Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement
by the International Study Group on Pancreatic Surgery (ISGPS). Tol JA, Gouma DJ, Bassi C, Dervenis C, Montorsi M,
Adham M, Andrén-Sandberg A, Asbun HJ, Bockhorn M, Büchler MW, Conlon KC, Fernández-Cruz L, Fingerhut A, Friess
H, Hartwig W, Izbicki JR, Lillemoe KD, Milicevic MN, Neoptolemos JP, Shrikhande SV, Vollmer CM, Yeo CJ, Charnley RM;
International Study Group on Pancreatic Surgery. Surgery. 2014 Sep;156(3):591-600
Lung
Mawhinney L, Armstrong ME, O’ Reilly C, Bucala R, Leng L, Fingerle-Rowson G, Fayne D, Keane MP, Tynan A, Maher L,
Cooke G, Lloyd D, Conroy H, Donnelly SC. Macrophage migration inhibitory factor (MIF) enzymatic activity and lung
cancer. Mol Med. 2015 Apr 16;20:729-35.
Smyth RJ, Fabre A, Dodd JD, Bartosik W, Gallagher CG, McKone EF. Pulmonary blastoma: a case report and review of
the literature. BMC Res Notes. 2014 May 13;7:294.
A. Costa Pozza, J.D. Dodd, M.W. Butler, S.C. Donnelly. M.P. Keane. An Audit of St Vincent’s University Hospital (SVUH)
Rapid Access Lung Cancer (RALC) Pathway 2014 as Part of the National Cancer Control Programme. Irish Journal of
Medical Science 2014 (183) Suppl 11.
L. McGrath-Soo, N. Abbas, A. Bates, K.A. Redmond, D. Healy, D. Eaton. Use of PleureX Catheter Drains in the
Management of Recurrent Pleural Effusions. Irish Journal of Medical Science 2014 (183) Suppl 11.
Page 71
Neuroendocrine tumours
Mohan H, Nicholson P, Winter DC, O’Shea D, O’Toole D, Geoghegan J, Maguire D, Hoti E, Traynor O, Cantwell CP.
Radiofrequency Ablation for Neuroendocrine Liver Metastases: A Systematic Review. J Vasc Interv Radiol.
Frilling A, Modlin IM, Kidd M, Russell C, Breitenstein S, Salem R, Kwekkeboom D, Lau WY, Klersy C, Vilgrain V, Davidson
B, Siegler M, Caplin M, Solcia E, Schilsky R; Working Group on Neuroendocrine Liver Metastases. Recommendations for
management of patients with neuroendocrine liver metastases. Lancet Oncol. 2014 Jan;15(1):e8-21.
Boland MR, Lowery AJ, Walsh S, Beddy D, Prichard RS, O’Shea D, Skehan SJ, McDermott EW. Incidental
Phaeochromocytoma on Staging PET-CT in a Patient with a Sigmoid Tumour and Situs Inversalis Totalis. Case Rep Surg.
2014;2014:645462.
Ducreux M, Dahan L, Smith D, O’Toole D, Lepère C, Dromain C, Vilgrain V,cBaudin E, Lombard-Bohas C, Scoazec JY, Seitz
JF, Bitoun L, Koné S, Mitry E. Bevacizumab combined with 5-FU/streptozocin in patients with progressive metastatic
well-differentiated pancreatic endocrine tumours (BETTER trial)—a phase II non- randomised trial. Eur J Cancer. 2014
Dec;50(18):3098-106.
Caplin ME, Baudin E, Ferolla P, Filosso P, Garcia-Yuste M, Lim E, Oberg K, Pelosi G, Perren A, Rossi RE, Travis WD; ENETS
consensus conference participants. Pulmonary neuroendocrine (carcinoid) tumors: European Neuroendocrine Tumor
Society expert consensus and recommendations for best practice for typical and atypical pulmonary carcinoids. Ann
Oncol. 2014 Feb 2. pii: mdv041.
McDermott S, O’Neill AC, Skehan SJ. Staging of gastroenteropancreatic neuroendocrine tumors: how we do it based on
an evidence-based approach. Clin Imaging. 2014 Mar-Apr;37(2):194-200.
Rectal carcinoids: a systematic review. McDermott FD, Heeney A, Courtney D, Mohan H, Winter D. Surg Endosc. 2014
Jul;28(7):2020-6.
Radiology
Boland MR, Lowery AJ, Walsh S, Beddy D, Prichard RS, O’Shea D, Skehan SJ, McDermott EW. Incidental
Phaeochromocytoma on Staging PET-CT in a Patient with a Sigmoid Tumour and Situs Inversalis Totalis. Case Rep
Surg. 2014;2014:645462.
Matthey-Gie ML, Walsh SM, O’Neill AC, Lowery A, Evoy D, Gibbons D, Prichard RS, Skehan S, McDermott EW.
Ultrasound predictors of malignancy in indeterminate thyroid nodules. Ir J Med Sci. 2014 Dec;183(4):633-7.
Primary retroperitoneal masses: what is the differential diagnosis? Scali EP, Chandler TM, Heffernan EJ, Coyle J,
Harris AC, Chang SD. Abdom Imaging. 2014 Dec 3
Early arterial stasis during resin-based yttrium-90 radioembolization: incidence and preliminary outcomes.
Piana PM, Bar V, Doyle L, Anne R, Sato T, Eschelman DJ, McCann JW, Gonsalves CF, Brown DB. HPB (Oxford). 2014
Apr;16(4):336-41
Pancreatic metastasectomy: experience of the Irish National Surgical Centre for Pancreatic Cancer. Redmond CE,
Adler H, Heneghan HM, Kelly R, Swan N, Cantwell CP, Maguire D, Traynor O, Hoti E, Geoghegan JG, Conlon KC. Ir J
Med Sci. 2014 Dec;183(4):677-80
Pancreaticoduodenectomy; expected post-operative anatomy and complications. McEvoy SH, Lavelle LP, Hoare
SM, O’Neill AC, Awan FN, Malone DE, Ryan ER, McCann JW, Heffernan EJ. Br J Radiol. 2014 Sep;87(1041)
Book: FDG PET/CT in Clinical Oncology: Case Based Approach with T eaching Points. J Mihailovic, SJ Goldsmith, RP
Killeen. Springer 2014.
Sarcoma
Combined management of retroperitoneal sarcoma with dose intensification radiotherapy and resection: longterm results of a prospective trial. Smith MJ, Ridgway PF, Catton CN, Cannell AJ, O’Sullivan B, Mikula LA, Jones JJ,
Swallow C. Radiother Oncol. 2014 Jan; 165-71
Gastrointestinal stromal tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Casali
PG, Blay JY, Bertuzzi A et al (ESMO working group) Ann Oncol. 2014 Sep;25 Suppl 3:iii21-6.
Bone sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Casali PG, Blay JY,
Bertuzzi A et al (ESMO working group) Ann Oncol. 2014 Sep;25 Suppl 3:iii113-23.
Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Casali
PG, Blay JY, Bertuzzi A et al (ESMO working group) Ann Oncol. 2014 Sep;25 Suppl 3:iii102-12.
Page 72
Medical Oncology/Publications 2014
Porta C, Levy A, Hawkins R, Castellano D, Bellmunt J, Nathan P, McDermott R, Wagstaff J, Donnellan P, McCaffrey
J, Vekeman F, Neary MP, Diaz J, Mehmud F, Duh MS. Impact of adverse events, treatment modifications, and
dose intensity on survival among patients with advanced renal cell carcinoma treated with first-line sunitinib: a
medical chart review across ten centers in five European countries. Cancer Med. 2014 Dec;3(6):1517-26.
SJ Cushen, DG Power, MY Teo, P McEneaney, MM Maher, R McDermott, K O’Sullivan and AM Ryan. Body
composition by computed tomography as a predictor of toxicity in patients with renal cell carcinoma treated
with sunitinib American Journal of Clinical Oncology, Mar 28.2014
Oh WK, McDermott D, Porta C, Levy A, Elaidi R, Scotte F, Hawkins R, Castellano D, Bellmunt J, Rha SY, Sun JM,
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