The ultimate goal of cancer services is to help people diagnosed with cancer live for longer, in many cases ‘curing’ them of the disease. The Government has set a goal of saving an additional 5,000 lives by 2014/15.
Finalists demonstrated an ability to deliver change which will ultimately result in cancer patients living longer.
Developing and implementing a community-based prostate health clinic in Newham for hard to reach men
North East London Cancer Network
The Newham community-based prostate clinic is an innovative model aimed at supporting the healthcare needs of men from hard-to-reach groups who often feel excluded from accessing healthcare support.
Based in an African and Caribbean Community Centre, the clinic attempted to map itself on to the needs of the service user rather than the other way round. Men could self-refer and did not need an appointment to attend; opening hours were flexible and specialist nurses and doctors operated a one-to-one service offering information and support about all aspects of prostate health. Following on from a consultation, service users could access diagnostic investigations on site with a follow-up in Secondary Care if necessary. Blood could be taken for PSA testing in clinic and the test carried out in the Acute Trust.
Men scored the clinic very highly in terms of access and convenience. They talked about the bespoke clinic with friends, with 25 per cent of men who visited the clinic doing so because of word-of-mouth referrals. This approach complemented the advertising campaign which promoted the clinic among a hard-to-reach group.
The pilot clinic provided a safe environment for these men to express fears or concerns that were not being addressed elsewhere: many symptomatic men who visited the clinic said that they would not have visited a GP citing a number of reasons, including fear, embarrassment or simply not thinking their worries were warranted.
The learnings gained from the pilot will be shared with other stakeholders both within London and across England. It is hoped that this clinic will be the first of many.
Increasing the uptake of extended pelvic lymphadenectomy for intermediate & high-risk prostate cancer in minimal access radical prostatectomy
The Royal Surrey County Hospital
The evidence in favour of performing extended pelvic lymphadenectomy (ePLND) during radical prostatectomy (RP) is now clear in terms of an improved cancer-specific survival (CSS) for patients with intermediate and high-risk prostate cancer regardless of whether the lymph nodes removed are involved (25 per cent improvement in CSS) or not involved (15 per cent improvement) by cancer.
This improvement in CSS has been demonstrated by several workers and has been recognised by international guideline-producing bodies, which now recommend that ePLND is performed during RP for these patients.
Despite these recommendations the rate of performing any form of lymph node dissection is falling, coincident with the rise of minimal access (laparoscopic and robotic) RP. The aim of this project was to standardise the surgical steps needed for laparoscopic ePLND and to determine its learning curve in order to allow its safe incorporation into existing laparoscopic and robotic RP programmes.
A prospective longitudinal study of 500 consecutive patients with intermediate- and high-risk prostate cancer having ePLND during RP was carried out. The surgical technique was progressively refined and the learning curve for ePLND was deduced by noting the changes in operating time, complications and lymph node (LN) yield in sequential cohorts of 100 patients. Lymph node parameters were compared with the results from the preceding 311 cases where limited ePLND was undertaken.
This project has demonstrated for the first time the learning curve of ePLND during minimal access RP, which has implications for training for surgeons in this technique and of planning operating lists. It has also standardised the technique in order to remove the largest number of LNs in the shortest time and with the fewest complications.
Finally, it has provided a large dataset of patients from which further information regarding the oncological consequences of ePLND will be forthcoming.
Early awareness and diagnosis of breast cancer in women aged 70+ - Berkshire Health Activist public involvement work
Thames Valley Cancer Network
Over 30 per cent of breast cancer diagnoses are for women aged 70+ and approximately 50 per cent of deaths from breast cancer are of women in this age group. The higher death rate in older women is due primarily to later presentation with breast cancer symptoms, which has an adverse affect on outcomes. Evidence shows that many older women are not aware that they are at continued risk of breast cancer.
The aim of this project was to raise awareness of breast cancer signs and symptoms among the 48,000 women aged 70+ across Berkshire, and among their families and friends. In addition to more traditional press advertising and a poster campaign, this project made extensive use of health activists to help get the message across.
The Berkshire Health Activists is a team of lay people, specially trained to communicate health promotion messages to the public. The activists are responsible for planning and delivering the community engagement element of the campaign.
During the course of the campaign the activists made face-to-face contact with over 4,000 members of the public in a wide range of groups and settings, including Women’s Institute, Age Concern, a variety of local mosques, carers’ groups, temples and church groups, senior citizens’ groups, libraries, charity shops, care homes and sheltered housing.
Independent market research demonstrated that the campaign was very effective in getting the message across to women aged 70+, and feedback from a sample of groups that received a presentation from one of the health activists was very positive.
The health activists’ professionalism, enthusiasm and wide range of contacts with community groups enabled them to make a very positive contribution to the breast cancer in women aged 70+ awareness raising campaign.
The awareness and early diagnosis of breast cancer in women aged 70+ was a Department of Health funded pilot project.