Life demands excellence
RM M A G A Z I N E SUMMER 2018
MARVELLOUS MEDICINES Meet the pharmacists ensuring that more patients benefit from biosimilars How The Royal Marsden Cancer Charity supports our vital work Transforming follow-up care
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At The Royal Marsden, we deal with cancer every day, so we understand how valuable life is. And when people entrust their lives to us, they have the right to demand the very best. That’s why the pursuit of excellence lies at the heart of everything we do.
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EXECUTIVE NOTES
CONTENTS 4 Bulletin What’s happening around The Royal Marsden 12 Reshaping care Why we’re changing the way we support patients after treatment 14 Making a difference How The Royal Marsden Cancer Charity funds the Trust’s work 18 Carbon copies Our drive to bring biosimilar drugs to cancer patients 21 It happened to me How a father deals with his son’s cancer diagnosis 22 Listening to public opinion
The importance of patient and public involvement in research
24 A day in the life Consultant Breast Radiographer Victoria Sinnett’s varied role 26 Fundraising News from The Royal Marsden Cancer Charity 28 Foundation news Updates from our Foundation Trust and Governors
WELCOME to the summer 2018 edition of RM, the magazine for our staff, patients, carers and Foundation Trust members. In this issue, we look at how The Royal Marsden Cancer Charity transforms the lives of our patients by funding our groundbreaking work. Philanthropy has always been at the heart of The Royal Marsden, and today, the support of the Charity allows us to continue saving and improving the lives of people with cancer. Read more on page 14. As well as pioneering new treatments for patients, we are always looking to improve and modernise follow-up care. On page 12, we highlight how The Royal Marsden is helping stable and cancer-free patients after their treatment ends. Our Chief Pharmacist, Jatinder Harchowal, is leading a revolution in the use of biosimilar drugs for cancer. We explore how this could save the NHS hundreds of millions of pounds a year, without compromising the clinical impact for patients (page 18). We also get an insight into a day in the life of Victoria Sinnett, our Consultant Breast Radiographer in Sutton, on page 24. I hope you enjoy reading this issue of RM.
30 Puzzles and prizes Test your wits and win a prize with our crossword 31 Stay in touch Your comments on social media, plus hospital contacts
Cally Palmer CBE, Chief Executive, The Royal Marsden
ON THE COVER Jatinder Harchowal, Chief Pharmacist
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B U L L E T I N W H AT ’ S H A P P E N I N G A R O U N D T H E R O YA L M A R S D E N
The NHS at 70 IT MIGHT LOOK LIKE something out of a James Bond movie, but this Mullard six-million-electronvolt (MeV) radiotherapy machine was leading-edge technology in 1967. This is one of many photos in The Royal Marsden’s archives, which we’ve delved into to mark the NHS’s 70th birthday this year. In fact, we’d started researching the use of radiation to diagnose and treat cancer patients as early as 1912, when we appointed our first physicist. During the Second World War, to avoid the risk of scattering radioactivity in the event of being bombed, radium was buried 40 feet deep in the garden. After the war, we became the first hospital in the UK to treat patients using radioisotopes. Building the Sutton hospital was a response to the need for more space for radiotherapy and radioisotope research, and the site was chosen partly for the fact that it slopes, making it easier to build spaces that could safely contain radiation in the basement. Want to know more? Read about the NHS70 celebrations at england.nhs.uk/nhs70
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? DID YOU KNOW? The new General Data Protection Regulation (GDPR) law came into effect on 25 May. To read our updated privacy policy, visit royalmarsden. nhs.uk/privacy
SCREEN TIME Mr Erik Mayer uses augmented reality at the da Vinci Xi console
Our surgeons trial augmented reality THE ROYAL MARSDEN is trialling the use of augmented reality during robotic surgery for patients with prostate, testicular or kidney cancer. Scans taken before surgery are superimposed onto the surgeon’s ‘view’ inside a patient’s body. This is displayed on a tablet device attached to the da Vinci Xi robot and within the robotic console itself. The image shows any target organs for the procedure, as well as the surrounding anatomy, to help guide the surgeon’s actions. Mr Erik Mayer, Consultant Surgeon, said: “Robotic surgical systems have rapidly advanced the field of minimally invasive surgery, but there is one key challenge compared to traditional open surgery: an increasing sensory distance between surgeon and patient. “As you lose the sensation of touch with robotic surgery and can’t feel the tissue, there is a growing interest in using augmented reality
to enhance the surgeon’s vision, providing them with crucial information to better guide surgery. “With this technology, surgeons will have a better appreciation of the target organ and surrounding anatomy, including revealing sub-surface structures that wouldn’t have been visible in open surgery. This gives the surgeon even greater control and tailors surgical dissection based on the patient’s anatomy.” This study is a collaboration between The Royal Marsden and the Imperial College Healthcare NHS Trust, supported by the National Institute for Health Research. It brings together the multidisciplinary expertise of surgeons, radiologists and engineers and aligns with the Cancer Research Centre of Excellence strategic partnership between Imperial College London and The Institute of Cancer Research. RM magazine 5
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HELPING STUDENTS DISCOVER SCIENCE S ue A lexander, Principal B iomedical S cientist and Pathology S ervices Manager, volunteered to help organise the S cience for Discovery S chools S cience Conference in A pril. The conference, attended by about 4 00 senior- school students, is aimed at schools where science is not well represented, as well as at students for whom E nglish isn’ t t ei t an a e or who are from less a ent a ea S ue said: “ It’ s important to mak e science accessible and understandable to those who may not regard it as something that they can relate to. “ The main aim is to showcase the vast number of careers a ai a e in t e e including the fact that you do not need a e ee to et off the ground.”
Want to know more? Visit science4u.info
LATEST RECRUIT Mr Marc Bullock
New fellow joins robotic surgery programme A NEW ROBOTIC surgery fellow has joined The Royal Marsden as part of our unique fellowship programme to train multidisciplinary robotic surgeons of the future. Mr Marc Bullock has been working as a Pelvic Exenteration Robotics Surgical Fellow since April. Thanks to supporters of The Royal Marsden Cancer Charity, The Royal Marsden has been pioneering surgery using the da Vinci robots since 2007. In 2015, after receiving a generous donation from the McCarthy family, we installed a da Vinci Xi,
which has a dual console that allows consultants to supervise trainees during live surgery. This capability enabled us to set up the Robotic Surgery Fellowship programme, which is also funded by Charity supporters. Another fellow is expected to join the fellowship programme – which aims to train a total of 10 robotic surgeons – later this year. Mr Bullock said: “As one of the leading cancer hospitals in the world, The Royal Marsden provides a unique blend of expertise unavailable elsewhere in the UK.
“By integrating multiple disciplines of surgical oncology, this fellowship is exceptionally forwardthinking, and will help redefine what is considered possible. It is an exciting time to be a surgical trainee, with such technological innovation that extends and improves the lives of patients.” Robotic surgery has several benefits for patients over open or keyhole surgery. Greater precision results in lower blood loss, less pain and smaller scars, which means patients recover faster and have shorter stays in hospital.
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BULLETIN
Decades of dedication THE ROYAL MARSDEN has recognised the longevity of more than 100 members of staff who have given a total of 1,500 years of service to the Trust. Held in March, our long service awards celebrated colleagues who have worked at The Royal Marsden for 10, 20, 30 or – in the case of Margaret Bidmead, Head of Physics and Radiotherapy Physics – 40 years. Attendees received their awards and enjoyed afternoon tea with Chief Executive Cally Palmer, who is celebrating 20 years at The Royal Marsden herself, and Chairman Charles Alexander. Margaret joined in 1978 as a junior medical physicist and now heads the clinical physics teams across both Sutton and Chelsea. She said: “The Royal Marsden invests in some of the newest equipment, and over my career, we have been able to evaluate and commission this technology and
influence how it is used in the clinic – both here and around the world. I find that very rewarding. “The main reason I’ve stayed so long, however, is the people that I work with, and being part of a team that works really well together.” Charles said: “We are all very proud to have so many people who provide such a dedicated service to our patients. “When I speak to patients and their families, I am consistently struck by the warmth of feeling they hold towards our staff. I put that down to the length of service of many staff members and the commitment and loyalty they have to the organisation, their colleagues, our patients and their families.”
“We are all very proud to have so many dedicated people”
Kidney cancer breakthrough
? DID YOU KNOW? In 2017/18, The Royal Marsden saw
55,997 patients – more than in any previous year.
Researchers have found that kidney cancer follows distinct evolutionary paths, enabling them to detect the aggressiveness of a tumour. The Tracking Cancer Evolution Through Therapy (TRACERx) renal study, led by Dr Samra Turajlic, Consultant Oncologist at The Royal Marsden, sheds light on the fundamental principles of cancer evolution. The findings, published across three papers in the journal Cell, could lead to clinical tests that give patients a more accurate prognosis and more personalised treatment. The team, based at the Francis Crick Institute and co-funded by The Royal Marsden and Cancer Research UK, analysed more than 1,000 kidney tumour samples from 100 patients in order to reconstruct the sequence of genetic events that led to them developing the disease. Dr Turajlic said: “The outcomes of patients diagnosed with kidney cancer vary a great deal. Knowing the next step in the cancer’s trajectory could tailor treatments in the next decade.”
FORTY NOT OUT Margaret Bidmead joined The Royal Marsden in 1978
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A NEW MODEL Under the RAPID pilot, men will have a prostate scan and biopsy on the same day
A ROYAL INVITATION S am W igfall, Matron in the H aemato- oncology U nit, attended a special reception for frontline nurses at B uck ingham Palace in March. S am was among a e ection o taff to attend the evening reception, hosted by H RH The Prince of W ales, who used the opportunity to praise the “ unsung and unseen” dedication of B ritain’ s nurses. S he said: “ It was a real privilege to be invited and it was lovely to meet so many nurses from across the country. I was quite nervous beforehand, but it was such a wonderful experience.”
Men offered RAPID diagnosis RM PARTNERS, THE CANCER ALLIANCE for northwest and southwest London hosted by The Royal Marsden, is piloting a new ‘one-stop’ clinic to ensure that diagnosing men with prostate cancer is quicker, easier and more efficient. The new scanning and diagnosis model, Rapid Assessment Prostate Imaging and Diagnosis (RAPID), is being trialled for two years at three hospitals: Charing Cross, Epsom, and Queen Mary’s in Roehampton. The usual process for men in London referred by their GP is an MRI scan, followed days or weeks later by a needle biopsy. With RAPID, men have a multiparametric
MRI scan, which creates an enhanced image of the prostate and is analysed by specialist uro-radiologists on the same day. Men whose scans show a very low risk of prostate cancer can safely avoid an unnecessary biopsy and have their care transferred back to their GP. Those who require further investigation are offered a transperineal fusion biopsy on the same day, if appropriate, which uses precision equipment that overlays ultrasound images with 3D MRI scans to guide the clinician to the suspect areas. This means fewer samples need to be taken and there is less risk of infection and other complications.
Disabled access guides now online Thanks to funding from The Royal Marsden Cancer Charity, the Trust has worked with DisabledGo to create online accessibility guides for The Royal Marsden’s hospitals in Chelsea and Sutton. The detailed guides help people with disabilities to plan their visits, and cover areas such as entrances, wards,
cafés and restaurants, reception areas, and waiting rooms. They include information on automatic doors, ramps, colour contrast in accessible toilets and wayfinding signage.
Want to know more? See the guides at disabledgo.com
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BULLETIN
Treatment combination success for melanoma A COMBINATION OF surgery and immunotherapy appears beneficial for patients with stage 4 metastatic melanoma, according to researchers from The Royal Marsden. Clinical Research Fellow Mr Henry Smith presented data alongside lead author Mr Myles Smith, Consultant Surgical Oncologist, at this year’s Society of Surgical Oncology Symposium in Chicago in March. Mr Myles Smith said: “We have seen an evolution in how we
“We are performing more procedures that ‘clear’ remaining disease after immunotherapy”
are managing such patients, performing more abdominal surgery and procedures that ‘clear’ remaining disease after immunotherapy. With surgery, we can also prevent some problems, meaning that patients can stay on their immunotherapy treatment for longer.” Competent multidisciplinary teams in this field are vital, the authors conclude, in order to manage these complex cases. Mr Andrew Hayes, Consultant Surgical Oncologist, was the lead author on another paper presented at the conference, which investigated a new combination of immunotherapy drugs in a laboratory setting. They found that the drugs prevented the progression of limb sarcomas when used alongside standard chemotherapy by isolated limb perfusion.
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FAST FACTS NHS70: The Royal Marsden through the years
1948 1963 The NHS is formed
Our Sutton hospital is officially opened on 20 May by Her Majesty The Queen
1986
The launch of the first randomised study using tamoxifen as a preventive measure against breast cancer
2005
The Oak Foundation Drug Development Unit opens at the Sutton hospital
MORE SURGERY Mr Myles Smith (left) and Mr Henry Smith
2017
The UK’s first MR Linac radiotherapy system is installed at The Royal Marsden and The Institute of Cancer Research RM magazine 9
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IN BRIEF
have negative nodes, and this total removal might expose them to the risk of lymphoedema, a major condition that can have a huge impact on a patient’s life. Q What did the FRIENDS feasibility study involve? A My colleague Mr Thomas Ind and I injected a fluorescent green dye into the cervix, which spread through to the nodes. Using a black-and-white ‘filter’ on the viewfinder of the da Vinci Xi surgical robot, we could find the first sentinel lymph nodes draining fluid from the cancer, which ‘flare up’ green in response to the dye. We could then remove these and send them for testing.
Frailty care prize
The Trust’s Surgical Frailty Transformation Programme has been highly commended in the Anaesthesia and Perioperative Medicine Team of the Year prize at this year’s BMJ Awards. Led by Dr Ramanathan Kasivisvanathan (above), the team implemented a package of care for frail patients before surgery, improving outcomes and shortening the average hospital stay.
Therapist’s fellowship
Tamsin L ongley, S enior O ccupational Therapist, has been awarded a W inston Churchill Memorial Trust F ellowship. S he will research international rehabilitation programmes for patients who develop think ing and memory problems after treatment, bringing best practice back to The Royal Marsden.
Oncologists honoured
Dr James Larkin and Professor Christopher Nutting have been elected to the prestigious Academy of Medical Sciences Fellowship. This recognises their invaluable contributions to advancements to oncology, translating research discoveries into benefits for cancer patients.
Q&A: SENTINEL LYMPH NODES Ms Marielle Nobbenhuis, Consultant Gynaecological Oncology Surgeon, discusses recent research that aims to better identify lymph nodes affected by cancer Q What are sentinel lymph nodes? A Lymph nodes are an important part of the body’s immune system. These nodes, or glands, act by filtering abnormal cells from lymphatic fluid – a colourless fluid that forms in the body’s tissues. Cancer often spreads through the lymphatic system, and sentinel nodes are the
first such areas to which cancer is likely to spread. Q Why are you researching this? A In early cervical and endometrial cancer, a standard course of action is a radical lymphadenectomy – the removal of all lymph nodes to assess the spread of disease in a biopsy. However, most patients
Q What did you find? A The results were overwhelmingly positive. In 95 per cent of the 53 women who were part of the study, we were able to successfully identify the sentinel lymph nodes. Q What does this mean for patients? A In addition to avoiding the risk of lymphoedema, the fact that the procedure is carried out robotically, as opposed to with keyhole or open surgery, has many benefits. It is minimally invasive – meaning better recovery and less pain and scarring – and the greater magnification means the surgeon can be much more precise.
“In 95 per cent of women in the study, we were able to successfully identify the sentinel lymph nodes”
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BULLETIN
Young patients tell their stories on TV PATIENTS AND STAFF in The Royal Marsden’s Oak Centre for Children and Young People (OCCYP) featured in a documentary in the BBC’s science series Horizon in June. Camera crews followed teenage and young adult patients and staff in the OCCYP for a month in late 2017. The one-hour programme – titled Teenagers Vs Cancer: A User’s Guide – focused on the impact a cancer diagnosis can have on young people and how the treatments have developed. Filmed at The Royal Marsden and Bristol Haematology and Oncology Centre, the documentary highlighted the issues faced by young people aged 16 to 24 and the support they receive while going through cancer treatment. Emma Masters, Advanced Nurse Practitioner in the OCCYP’s
ON THE HORIZON Harry Goodburn took part in the documentary
teenage and young adult ward, said: “It was quite surreal to have a camera crew following us around on the ward. “The patients that were filmed seemed to quite enjoy the experience. We were happy to take part to help raise awareness of what our patients go through during their treatment and the services we offer.” Patient Harry Goodburn, 20, was filmed before, during and after his stem cell transplant at The Royal Marsden. He said: “It was definitely strange to begin with, but it wasn’t overly hard to get used to being filmed, especially with all the other procedures going on around me. “In a way, the filming was quite a pleasant distraction. It was good to be able to share what it’s been like for me to be treated at The Royal Marsden.”
How palliative care helps all The Royal Marsden’ s Integrated S ymptom Control and Palliative Care service has produced a video to raise awareness of the support available to patients. W hile palliative care is sometimes thought to be synonymous with end- oflife care, that’ s not the case at The Royal Marsden. Patients experiencing pain, nausea, poor appetite and weight loss, lack of energy or mo i it i c tie o t o e with emotional, social or family issues – such as parents with young children – can be referred to palliative care at any point during their treatment. The multidisciplinary team comprises doctors, specialist nurses, physiotherapists, occupational therapists, dietitians, psychologists an a ene t a i o Patient Maureen V ine said: “ A ngela, the palliative care clinical nurse specialist, calls me at home between appointments to check on how I’ m doing and talk about diet and tak ing care of myself. The whole team has such a positive approach.” Dr J ayne W ood, Consultant Palliative Medicine and Clinical L ead, said: “ W e’ re here to meet patients’ needs, support them and their families, and ensure they have the best quality of life.”
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OPEN ACCESS Dr Kate Newbold
Reducing thyroid check-ups
R E SH A PING CA R E With more people than ever being diagnosed with and surviving cancer, outpatient clinics are seeing greater numbers of patients who are considered disease-free and able to return to normal life. So The Royal Marsden is modernising how it provides follow-up care to enhance support after treatment
Our thyroid cancer patients continue to come for annual check-ups for the rest of their lives due to the disease’s tendency to grow slowly. So in summer 2017, The Royal Marsden launched the UK’s first open-access follow-up clinic for thyroid patients in the UK. “Every year, we gain more and more patients as they are never discharged,” says Dr Kate Newbold, Consultant Clinical Oncologist and clinical lead for thyroid cancer. “It’s not ideal for patients who have to come in for a blood test and then wait in increasingly busy clinics for a brief catch-up and a nod that they are fine for another year. We see at least 10 patients a week who have been disease-free for more than a decade and are what we would consider stable. “The open-access clinic means that patients who have been stable for 10 years are invited to come in at their convenience for a blood test and to fill in a simple questionnaire, then we call them with the results. All patients agree to this under the proviso that they can come in if there is anything they would like to talk about in person. “Patients have been pleased with the pathway so far, as it saves them taking time out of their busy lives to sit in a clinic for a consultation.”
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FSOULRLGOEWR-YU PF OCCAURSE
A new pathway for prostate patients Men who have had curative treatment for localised prostate cancer were historically followed up indefinitely, with very few patients being discharged – but this model has been transformed. The Royal Marsden’s stratified follow-up pathway opened in December 2015 with the aim of reducing the number of unnecessary outpatient appointments after treatment ends, while better meeting patients’ long-term physical needs. Netty Kinsella, Nurse Consultant in the Urology Unit, set up the new pathway. She says: “We started with a prehabilitation programme to ensure that men undergoing prostate cancer treatment were well informed about their pathway, and optimised their recovery by introducing good dietary and exercise habits before treatment that they could recommence after treatment. “This foundation work really empowers patients to self-manage or escalate to us without waiting for their follow-up appointment. Most patients are now discharged after two years with most or all of their side effects addressed.”
Support after breast treatment In 2011, The Royal Marsden’s breast cancer team was one of the first in the UK to fully develop and sustain
SUPPORT PACKAGE Netty Kinsella (above) and Nikki Snuggs (below left)
an ‘open access’ pathway to better support all patients completing breast cancer treatment. Nikki Snuggs, Matron in the Breast and Plastics Unit, says: “Patients with no concerns were coming here unnecessarily to wait in busy clinics for short appointments that mainly addressed mammogram results and didn’t deal with survivorship issues such as relationships, returning to work, exercise, quitting smoking and long-term complications of treatment. “Meanwhile, patients who recognised signs and symptoms of metastatic disease between their conventional follow-up appointments were presenting to their GPs and
being referred to local hospitals, meaning delays in getting back into The Royal Marsden for treatment.” Today, breast cancer patients attend an end-of-treatment clinic, where they are given support to help them navigate this period of their lives. This includes advice about the signs and symptoms to look out for and how to manage possible long-term side effects of treatment, and an invitation to a Royal Marsden-led event promoting healthier living. Crucially, patients are monitored with an annual mammogram and phone consultation, and can call a dedicated clinical nurse specialist at any time with any concerns. RM RM magazine 13
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MAKING A DIFFERENCE The Royal Marsden’s work wouldn’t be possible without the support of The Royal Marsden Cancer Charity. We highlight how the money it raises helps the Trust to care for patients AT THE HEART of our Chelsea hospital, on the walls of the Regency staircase, are two enormous 19th-century oil paintings. One shows Dr William Marsden, who founded the world’s first free cancer hospital in 1851 after losing his wife to cancer; the other depicts Baroness Burdett-Coutts, whose loan of £3,000 enabled Dr Marsden to buy the land that The Royal Marsden occupies today. These portraits serve as a reminder that philanthropy has always been at the centre of The Royal Marsden’s work. Today, that tradition is upheld by The Royal Marsden Cancer Charity, which exists solely to raise funds to support the efforts of the Trust. Thanks to its dedicated supporters, the Charity invested a record £31 million in research, equipment, treatment and care, and patient environments in 2017, so we can continue – under the watchful gaze of our early benefactors – to save and improve the lives of people with cancer everywhere.
Life-saving research In the last financial year, the Charity committed more than £18 million to fund the Trust’s clinical and translational research programme – which includes large-scale national trials and gives patients access to the latest breakthrough drugs and best possible treatments – over the next five years. In 2014, the West Wing Clinical Research Centre in Sutton, for patients on clinical trials, was funded by donors who left gifts to the Charity in their Wills. And in 2016, the Ralph Lauren Centre for Breast Cancer Research was made possible thanks to the generosity of many of the Charity’s supporters, including philanthropist Ralph Lauren. For more than 15 years, Oak Foundation has also had a huge impact on The Royal Marsden’s research capabilities. Not only did it fund the Oak Foundation Drug Development Unit, one of the world’s largest facilities dedicated to testing new cancer therapies, it has also contributed to our paediatric >
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CHARITY FOCUS
CHARITY SUPPORT Clockwise, from below: Professor Mitch Dowsett (centre), Head of the Ralph Lauren Centre for Breast Cancer Research, with David Evans, Clinical Support Officer; the West Wing Clinical Research Centre; CyberKnife; the children’s radiotherapy waiting area
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drug development programme. This has helped us to increase the number of Phase I and II drug trials for children and adolescents from seven in 2009 to 23 in 2016, leading to more than 100 young cancer patients gaining access to new drugs that show real promise. Dr Lynley Marshall, who leads the Paediatric and Adolescent Oncology Drug Development Team, says: “We make leading-edge treatments and ‘first-in-child’ drugs available to children and young people with advanced cancer, which brings hope in difficult situations. It’s incredibly rewarding when a patient has a good response to a new drug.”
WORK AND PLAY The Charity committed more than £18 million to research in 2016/17 (below left); surgeon Mr Declan Cahill and the da Vinci Xi (below right); young patient Pippa Vickers with play specialist Claire Riddell (right)
Head and neck cancer patient Alison McDonald was treated on the TrueBeam, the most advanced technology of its kind in the world. She says: “I felt like I was about to have something new and futuristic. I was absolutely fascinated by the machine – I felt that I was receiving the very best care in the leading facility for radiotherapy.” For some cancer types, the da Vinci Xi surgical robot, funded by philanthropist Don McCarthy and his family, offers the best possible option, with shorter operations, fewer scars and faster recovery. Thanks to the da Vinci Xi’s dual console capability, experienced surgeons are now training the next generation of robotic experts in our unique Robotic Surgery Fellowship, which is also funded by the Charity. World-leading treatment and care High-quality care has a significant impact on patients’ experience and their ability to undergo and recover from demanding treatment. This is why the Charity funds our psychological care, family support and pastoral support services, which
help patients and their families deal with their diagnosis and treatment by providing emotional advice and practical information. And in the Charity-funded Oak Centre for Children and Young People (OCCYP), our incredible play specialists help children cope with cancer treatment. Thanks to a grant from the Chancellor of the Exchequer using LIBOR funds, the Charity has been able to fund the play specialists until 2021. Play specialists develop a programme of activities – including painting with plastic syringes or acting out situations with puppets – for each child, and work with them to boost their confidence and help them understand their treatment. As well as helping children to cope in difficult situations – such as lying still during radiotherapy to prevent the need for general anaesthetic – play specialists improve their patients’ long-term psychological wellbeing. Laura Vickers, mum of sevenyear-old patient Pippa, says: “Everyone at The Royal Marsden has been fantastic, but the play
Young patient Sophie Armitage came to The Royal Marsden for an experimental drug to shrink a rare type of cancer that was affecting her airways. Her dad, Tom, says: “Sophie’s 14 now and, apart from regular hospital visits, she’s doing activities you would expect a healthy teenager to do.” State-of-the-art equipment Investing in the latest equipment allows The Royal Marsden to give patients the best possible treatment. The Charity has funded hightech radiotherapy machines such as CyberKnife and the Varian TrueBeam, as well as contributing to the cost of the UK’s first-ever MR Linac, a joint venture with The Institute of Cancer Research (ICR). These enable us to provide shorter, more targeted treatments for patients, resulting in quicker recovery times and fewer long-term side effects. 16 RM magazine
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CHARITY FOCUS
HOW THE CHARITY RAISES MONEY FOR THE TRUST Legacies By leaving a gift in their Wills, Charity supporters make a vital difference to help improve the lives of people with cancer, long into the future –
Community fundraising Supporters hold their own fundraising events or take on a sponsored challenge such as The Marsden March or a skydive – specialists are particularly amazing. They are always willing to do what the children want, so Pippa will get them to play card games, even while hooked up to chemotherapy.” Modern patient environments We know that welcoming, peaceful environments can enhance the physical health and emotional wellbeing of The Royal Marsden’s patients and their families. The Charity has enabled the refurbishment of the waiting room for children and adolescents in our Radiotherapy Department to help young patients feel calmer and more relaxed when waiting for treatment. They’re often so distracted by the toys and games that they forget about their forthcoming treatment, and the positive effect also benefits the parents and siblings waiting with them.
Also, the parents’ room in the OCCYP was renovated with the support of jewellery manufacturer and retailer Pandora. Yanjmaa Nyamsuren, mum of four-year-old patient Michid, says: “When my son was really poorly, I didn’t want to cry next to him, so the parents’ room gave me some privacy. It’s also a nice space to gather your thoughts, watch TV or meet other parents going through the same thing.” Now, in its most ambitious appeal yet, the Charity is aiming to raise £70 million to build the Clinical Care and Research Centre in Sutton. This will bring pioneering research, advanced equipment, specialist treatment and care, and world-class patient environments together under one roof. RM
Want to know more? Visit royalmarsden.org
“The Royal Marsden’s play specialists are particularly amazing”
Individual giving Supporters make regular or one-off donations – for example, by donating to appeals, fundraising through a special occasion, sponsoring a day on the calendar wall in the hospital, donating in someone’s memory, or naming a loved one on our Christmas tree –
Philanthropy Philanthropists, foundations and corporate partners make generous donations in support of our work RM magazine 17
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BIOSIMILARS
CARBON COPIES The Royal Marsden has led the drive to bring biosimilars – near-identical replicas of vital drugs that are just as effective as the originals, yet cost far less – to more cancer patients THE HEALTHCARE AND pharmaceutical industries are on the cusp of a revolution in the use of biosimilars – ‘copycat’ drugs that could save the NHS hundreds of millions of pounds while providing the same benefits for patients. Biosimilars are copies of biological drugs – or biologics – such as monoclonal antibodies. These differ from common medicines, such as aspirin, which are relatively simple chemical structures. By contrast, biologics are large and extremely complex structures that are harvested directly from biological cells. Due to their complexity, they are expensive and can take up to 10 years to develop. Biosimilars typically take up to eight years to produce and approve. Scientists develop them by isolating every bend and fold
IN THE PHARMACY Jatinder Harchowal led the RM Partners biosimilars project (left); the biosimilar version of rituximab (right)
in a biologic’s primary structure before duplicating this ‘recipe’ in the laboratory, so that the molecular profile of the biosimilar matches the reference product. Although biosimilars have been around for more than a decade, it is only now that patents are starting to expire on widely used biological treatments for cancer and other serious diseases, and this is when biosimilars can be introduced. Copy and save Jatinder Harchowal, The Royal Marsden’s Chief Pharmacist, led a groundbreaking project to increase the adoption of a new generation of biosimilars across England in his role as Medicines Optimisation Lead of RM Partners, along with Tim McCarthy, Drug Resource Manager and NHS England Clinical Commissioning Pharmacist. Hosted by The Royal Marsden, RM Partners is part of the NHS Cancer Vanguard’s local delivery system across northwest and southwest London. Biosimilars are a key element of NHS England’s National Cancer Strategy to develop new models of care for cancer. “Biosimilars offer a really rare opportunity to help manage rising costs in the NHS, while maintaining the same clinical impact for our patients,” says > RM magazine 19
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BIOSIMILARS
Jatinder. “This means we can treat more patients, and the money saved can be reinvested into the NHS.” Explaining why biosimilars are so much cheaper than the original drug, he says: “For biosimilars, the pyramid of drug development is inverted. More work is done in early-phase trials to demonstrate a high similarity in safety and effectiveness between the copy version and the original drug, with less investment required in costly Phase III patient trials. As a result, we have seen the cost of biosimilars become 50-60 per cent cheaper.” The Royal Marsden was one of the first UK trusts to switch to the biosimilar of rituximab (also known as Mabthera), an important drug for treating blood cancers. Jatinder led a Cancer Vanguard programme to develop educational materials, policies and patient information with the Lymphoma Association, all of which supported the nationwide adoption of the biosimilar. Any cancer centre across the country could access these resources via a dedicated
“We are reaching a tipping point for biosimilars, with more on the way” website, which “ensured a consistent approach and avoided duplication of effort”, he says. Within months, 80 per cent of eligible patients across England had been switched to biosimilar rituximab. If used nationwide, this biosimilar alone could save the NHS up to £100 million a year. Cancer and beyond Consultant Haematologist Dr Sunil Iyengar is using biosimilar rituximab to treat patients with lymphomas, the fifth most common type of cancer in the UK. He says:
VITAL WORK Tim McCarthy
Q&A Tim McCarthy, Drug Resource Manager, explains more about biosimilars and how they are used at The Royal Marsden Q Are biosimilars as safe and effective as the original drug? A Yes. In order to be approved, biosimilars need to show that they are just as effective and safe as the original biologic. They go through the same Phase I and II drug trials, and some work is also done at Phase III.
“Over the past 15 years, rituximab has been a game-changer in our field and clinicians see it as one of their most effective treatments. “When a biosimilar version comes along, there’s understandable concern about it having the same clinical impact for patients, which sometimes creates a barrier to adoption. That’s why the NHS Cancer Vanguard is so important: raising awareness among patients and clinicians, as well as reassuring them about their effectiveness.” However, the impact of biosimilars reaches far beyond cancer. The work of RM Partners and The Royal Marsden is now being used as a model to implement non-cancer biosimilar drugs across the country, including biosimilar adalimumab (Humira) for arthritis. Jatinder says: “We are reaching a tipping point for biosimilars, with many more in the pipeline this year. Adalimumab is the biggest drug in the NHS, with a yearly spend of around £350 million, so the saving is potentially vast. “Our work has shown that biosimilars can be incorporated into treatment plans quickly and without compromising the safety of our patients.” RM
Want to know more? Watch Jatinder talk about biosimilars in our video at vimeo.com/royalmarsden
Q What are the advantages of using biosimilars over the original drug? A They don’t have significant clinical benefits over and above the original drug, but clinical outcomes for patients are highly similar. They are, however, much less expensive, meaning that we can treat many more patients at a lower cost. Q Other than rituximab, what biosimilars are currently in use at The Royal Marsden? A A biosimilar copy of trastuzumab (Herceptin) is now available, and we are exploring its use in other NHS trusts. We have also introduced a biosimilar infliximab, which is used to treat immunotherapy-induced colitis. Q What new cancer biosimilars are on the way? A There is a raft of new biosimilars in development, including biosimilar cetuximab for head and neck and colorectal cancers, and biosimilar bevacizumab for colorectal, lung and breast cancers. Q How do patients know if they’re being given an original drug or a biosimilar? A Before switching from a biologic to a biosimilar, patients are given information to reassure them that biosimilars are just as safe and effective. They can choose to revert to the original drug if they wish, after a discussion with their clinical team.
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IT HAPPENED TO ME
I LOST MY WIFE TO CANCER. NOW MY SON IS A PATIENT. THE ROYAL MARSDEN HAS HELPED US BOTH TO COPE Martin McLagan, 55, father of testicular cancer patient Cameron, 20
WHEN A LOVED ONE is diagnosed with cancer, an overwhelming feeling of guilt really sets in. Everything I said appeared futile when my late wife Jackie, then 33, was told she had advanced breast cancer. Our only child, Cameron, was just one year old at the time. Jackie passed away when Cameron was 12. Seven years later, those feelings of guilt and futility came flooding back when
he was diagnosed with testicular cancer in exactly the same consulting room at The Royal Marsden where Jackie had been diagnosed all those years before. In September 2017, Cameron had just started his second year at university when he called me to say he was in hospital with fluid on his lung. It brought back memories of his mum’s illness, as she had suffered greatly from this
in her last five years. Days later, we were sitting in the outpatient clinic room at The Royal Marsden to see Professor Robert Huddart and my emotions were in turmoil. Cameron, now 20, has displayed his mum’s qualities from the start. We have always had a ‘let’s get on with it’ attitude – it was the only way we could come to terms with the cards life was dealing us. I had managed to shelter Cameron from the 11 years of treatment his mum went through, so coming to The Royal Marsden was not a dreaded experience for him. For me, coming back here was surprisingly OK, despite the fact that it was where Jackie passed away. I was just glad that Cameron could be treated in the Oak Centre for Children and Young People, as it’s a world away from what I’d expect in a hospital facility. My biggest worry was that Cameron would be scared by my experience of cancer. But one of The Royal Marsden’s psychologists helped me manage that worry by explaining that I had to keep him floating at the right level, like a balloon. Cancer obviously creates many negatives in everyone’s lives, but it has also made Cameron and I very close. I know that Jackie would be very proud of how he has developed as a young man. RM
Professor Robert Huddart
Consultant Clinical Oncologist, says: “The diagnosis of cancer at any time of your life is a stressful experience, and this is magnified when a close family member has already been affected. “Both Cameron and his dad have been really positive and focused throughout the treatment, and even managed to walk The Marsden March together. “For most young men like Cameron, this is an episode that we can work through and allow him to carry on with a normal future. He has been a pleasure to treat.”
“A ‘let’s get on with it’ attitude was the only way to come to terms with the cards life was dealing us” RM magazine 21
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L IS T E NING T O
PUBLIC OPINION Members of the public play a vital role in shaping The Royal Marsden’s cancer research, ensuring our work is relevant to patients INVOLVING PATIENTS AND the public in the design of cancer research is a crucial part of how we translate leading-edge science into clinical practice. At The Royal Marsden, patient and public involvement (PPI) ensures that the views of people who have experience of coming here for cancer treatment are represented when we design
clinical trials. This also helps us to ensure that the materials we use to communicate with patients about research are easy to understand and answer all their questions. Any patient, carer or member of the public can volunteer to become a PPI colleague and work with our researchers and clinical teams to develop, review and conduct research.
PPI colleagues contribute to our research in a variety of ways. They may take part in discussion groups about our research priorities, or be asked for their views on how a clinical trial is designed – for example, whether the aim of the study is clear and whether what is being asked of patients is feasible. Volunteers can also review research papers at home if they prefer.
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PPI
MEET TWO OF OUR PPI COLLEAGUES
“We’re grateful to those patients who give their time to support our research” The patient and carer research review panel meets four times a year to listen to our researchers present their forthcoming studies. Panel members are then asked to contribute to the formal review process for approving new clinical trials, and to comment on research proposals and other materials such as the trial protocols and patient information leaflets. Researchers then incorporate this feedback before submitting their trials to the national Research Ethics Service for approval to proceed. Professor David Cunningham, Director of Clinical Research, says: “The contribution of patients can be extremely valuable, providing alternative views to those of the research team. “Patients are able to make judgements based on their understanding of their condition and may have different thoughts about health outcomes that academics and researchers may not have considered. “It’s extremely important to have such a committed group of patients who are willing to give their time to support our research in this way. I’m incredibly grateful to them for their input.” RM
Want to know more? Visit royalmarsden.nhs.uk/ our-research/patient-involvement to learn more about PPI
John Braun
Martin Lee
“I’ve been a prostate cancer patient at the Chelsea site since 2013. I first became involved in PPI after attending a members’ event. I have since regularly attended the quarterly meetings of the patient and carer research review panel, and have hosted two PPI training sessions for researchers and patients. “I’m working on a study funded by the National Institute for Health Research (NIHR) that aims to develop new software to measure the response to chemotherapy in patients whose prostate cancer has spread to the bones. Researchers are comparing a combination of the software and whole-body MRI scans with the current standard pathway of conventional CT and bone scans. “As part of my involvement, I volunteered to receive an hour-long whole-body scan, complete with imaging coils from head to thigh. This experience has enabled me to better describe the technique to the patients who are being recruited to the trial, and will also help shape future information sheets on MRI studies.”
“I’m working with my fellow PPI colleague John Braun on the same NIHR-funded study. Whereas John is helping on the imaging side of things and sits on the Imaging Committee, I am on the Software Committee. “I’d worked in the offshore oil and gas industry and in commercial aviation, but after undergoing chemotherapy and radiotherapy at The Royal Marsden for a tongue tumour that had spread to my lower jaw, I wasn’t able to continue working. “I developed a keen interest in the science of research and joined The Royal Marsden’s patient and carer research review panel. I’m also a patient representative for other facilities. “The whole process – from the research idea through to patient recruitment, working with researchers at the top of their game, and the continued progress in potential treatments – makes it a very rewarding experience. “My latest interest is in raising awareness of PPI in nuclear medicine research and associated imaging.”
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A DAY IN T HE L IF E OF
VICTORIA SINNET T CONSULTA N T BRE AS T RADIOGRAPHER
VARIED ROLE Victoria sees patients with breast symptoms in the RDAC, reviews diagnostic scans and works with multidisciplinary colleagues
MY ROLE AS a Consultant Breast Radiographer in Sutton involves seeing patients for imaging examinations such as ultrasound and mammography, as well as performing biopsies and excisions. Once a week, I lead a multidisciplinary team meeting in which radiologists, surgeons and clinical nurse specialists discuss the images and biopsy results of patients whose mammograms or ultrasounds are indeterminate. We want to ensure that all the results from examinations, biopsies and imaging fit together to make a firm diagnosis so we can decide the best course of action. Triple assessment I then head to our clinic in the Rapid Diagnostic and Assessment Centre (RDAC). I’ll see patients who have been referred by their GP with a breast symptom and need to be seen within the recommended two-week period. This is an anxious time for the patient, so we aim to reassure them and make the process as straightforward as possible.
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A D AY I N T H E L I F E
During our clinics, we also see patients who are undergoing chemotherapy. They come to us for imaging to find out if the treatment is shrinking the tumour. I will also see patients who are going into surgery that morning. Because patients are increasingly being diagnosed in the early stages of breast cancer – which is good news – the tumours are often relatively small and can’t be felt by the surgeon. So, using ultrasound or mammography, we insert a small wire into the breast to guide the surgeons to the tumour, so only the cancer is removed, and not the healthy surrounding tissue. We usually carry out a ‘triple assessment’, which is an initial clinical examination, followed by a mammogram, if the patient is over 40, and an ultrasound. Then we’ll decide if an interventional biopsy is required. At this stage, I hope to tell them that they don’t have cancer – but of course, I often have to break the news that they do. This isn’t an easy part of the job, but I try to deliver the news in a way that is manageable, reassuring the patient that we’ve caught the cancer early and that they’re in the right place for treatment. They then wait for the conclusive results from their biopsy, and are seen by a consultant surgeon who will recommend a course of treatment.
“It’s an anxious time for the patient, so we make it as straightforward as possible”
Trialling new techniques I am also involved in research. In the Magseed trial, for example, we place a tiny marker the size of a grain of rice into the breast instead of a wire prior to surgery. This reduces the number of procedures the patient needs on the day of surgery and will improve efficiency. Another trial, called KORTUC, involves injecting a drug into tumours immediately before radiotherapy, under ultrasound guidance. We are hoping that this will make the tumour more receptive to this treatment. We are the only centre in the UK to be carrying out this trial, and hope that the results could be good news for patients with incurable breast cancers. I love my job: it’s varied, I get to meet many wonderful patients and I work with a great team. I am also incredibly proud that our department has been accredited under the Imaging Services Accreditation Scheme. This is not easy to achieve and is proof that RDAC imaging provides a top-quality service. RM RM magazine 25
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AND WE’RE OFF! The Royal Marsden’s Dr Nicholas van As, Dr Liz Bishop and Eamonn Sullivan (above) joined thousands of supporters
Ain’t snow stopping us now! Thousands of supporters braved the chill to take on this year’s Marsden March DESPITE FIVE DAYS of extreme weather from the Beast from the East in the run-up to The Marsden March, the annual 14-mile walk between our two hospitals was able to go ahead this year as the snow and ice melted and gave way to blue skies. More than 5,500 patients, families, supporters, staff and volunteers came together to raise vital funds for The Royal Marsden Cancer
Charity on Sunday 4 March. The Royal Marsden’s Medical Director Dr Nicholas van As, Chief Operating Officer and Deputy Chief Executive Dr Liz Bishop, and Chief Nurse Eamonn Sullivan cut the ribbon to begin the walk. Donations are still coming in, but the early indications are that it was an incredibly successful event, with more than £1.7 million raised so far. The Marsden March, sponsored by Banham, simply
couldn’t happen without the support of all our inspirational supporters and volunteers. We’re also incredibly grateful for all the work that goes on behind the scenes, by teams such as Estates, Facilities, Catering and ISS. An enormous thank you to everyone who took part, made a donation or volunteered on the day. The funds raised will go towards state-of-the-art equipment and groundbreaking research.
Want to know more? See more photos from this year’s Marsden March and sign up for early-bird alerts about the 2019 event at royalmarsden.org/march
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T H E R O YA L M A R S D E N C A N C E R C H A R I T Y
IN THE RUNNING A magical mystery tour
If you need extra inspiration, then look no further than our fantastic team of 99 runners who completed the London Marathon earlier this year, raising more than £380,000 in aid of the Charity. The team included four staff members: Divisional Nurse Director Mo Carruthers, Consultant Radiographer Briony Bishop, Philanthropy Manager Julia Tracey and Chief Financial Officer Marcus Thorman. Mo said: “The Charity supports so much of what allows us to go above and beyond at The Royal Marsden. I’ve seen my own patients benefit hugely from the things it has funded, like the da Vinci robot and the refurbishment of Ellis and Horder wards. “It was incredibly hard on the day, but the reasons I signed up kept me going and I was incredibly thrilled to complete the race.”
Join us on 29 and 30 September for our second-ever Marsden Mysteries – an unforgettable adventure around the historic streets of London and, for the first time, Sutton. By solving a series of fun clues and conundrums, you can raise money for The Royal Marsden Cancer Charity and improve the lives of people affected by cancer. It’s a great activity to do with kids or as a group of friends. Last year, 70 teams took part in the inaugural event as Dr William Marsden guided treasure hunters around the streets of Chelsea. One team, the Adamites, said: “We had a fantastic time. The clues were very well thought out and we’d definitely do it again!” This year, there’ll be a brand-new set of clues – so get your thinking caps on and register now!
Want to know more?
Want to know more?
To join our Royal Parks team, visit royalmarsden.org/ royal-parks-half-marathon
Visit royalmarsden.org/ marsden-mysteries
AT THE FINISH Staff Nurse Katy Hedges ran the Royal Parks Half Marathon last year
FANCY TAKING ON a challenge with The Royal Marsden Cancer Charity’s biggest-ever running team? Then sign up to take part in the Royal Parks Half Marathon on 14 October. We have places for 400 runners to take on one of the UK’s most beautiful races, which goes through four Royal Parks and past central London landmarks on its 13.1-mile route. Katy Hedges, Staff Nurse on the Oak Ward for Children and Young People, was
among those who ran for our team last year. She said: “I ran the Royal Parks Half Marathon to help raise funds for an amazing charity that supports this world-class hospital. It really is a special place, and I feel blessed to be part of the amazing team who work there. “The race was really hard, but I was inspired to keep going by thinking about my patients and my colleagues, and the money I was raising to help them.”
Contact The Royal Marsden Cancer Charity Telephone 020 8770 0279 Email charity@royalmarsden.org Visit royalmarsden.org Registered Charity No. 1095197 RM magazine 27
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A SUCCE S SFUL MEMBERS’ WEEK SOME OF YOU may have met our Governors or seen them around the hospital wearing their sashes during this year’s Members’ Week, held from 16 to 20 April. The aim of the week-long event is to recruit new members and give Governors the chance to meet and engage with the public. Our Governors led the activities for the week, which included walkabouts around the Sutton and Chelsea hospitals and visits to outpatient areas to meet patients and visitors. Governors also spoke with people at their stand to explain the benefits of our free membership, with promotional goodies at the ready for those who signed up. Visitors also had the opportunity to meet our Governors at a drop-in session held on Tuesday 17 April, as well as to chat with the Trust’s Chief Nurse, Eamonn Sullivan, over refreshments. Our Governors are delighted with the results of Members’ Week, as they recruited 225 new members and spoke to many other visitors on a number of important issues. The Trust would like to thank all of the Governors involved for making the week a huge success. IT’S GOOD TO TALK Governor Carol Joseph and Chief Nurse Eamonn Sullivan (top), and Governors Robert Freeman and Armine Afrikian (right), meet members of the public
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F O U N DAT I O N N E W S
HOW WE STORE AND USE YOUR INFORMATION Dates for your diary
WELCOME TO TWO NEW GOVERNORS WE ARE DELIGHTED to welcome two new Public Governors to the Council of Governors, representing the Elsewhere in England constituencies. In March, Ros McTaggart joined the Council and spent her first day in the role attending the Governors’ training day in Chelsea. Ros has worked in the events industry for nearly 30 years across both commercial and government sectors. She said: “I witnessed the care and treatment provided by The Royal Marsden during the time a family member was a patient.
I was impressed and grateful for the care they received.” Following the elections, which closed in April, we also welcomed Dr Ann Smith. During her career, Ann spent 28 years mostly in healthcare, but also in academia and research. This included 10 years working in The Royal Marsden as Head of the Stem Cell Transplant Laboratory prior to her retirement from the NHS in 2015. Ann decided to become a Governor as she appreciates and respects the Trust’s ethos of providing an excellent service to patients and their families throughout their cancer journey. She said: “I would very much like to continue to be involved with The Royal Marsden and contribute to the Trust and the wider community as part of the team of Governors.” ON THE COUNCIL Ros McTaggart (above) and Ann Smith (left)
Board of Directors meeting 26 September, 3.30pm-5pm, Chelsea Annual General Meeting 26 September, 5.30pm-7pm, Chelsea Council of Governors meeting 3 October, 11am-1pm, Sutton To attend any of these meetings, please call 020 7808 2844 or email trust. foundation@ rmh.nhs.uk
Keep in touch Become a member and/or contact your Governor: telephone 020 7808 2844, email trust. foundation@ rmh.nhs.uk or visit royalmarsden. nhs.uk/ membership
The General Data Protection Regulation (GDPR) came into effect on 25 May, and is the biggest change in data protection laws for 20 years. Personal data provided by members of the Trust will be processed for membership and service evaluation purposes only, and in accordance with these legitimate interests under the GDPR. Please note that the Trust will share some of this information with relevant third parties – for example, for the purposes of administering independent democratic elections. Your information is stored on a secure database with limited authorised access for the purposes set out above. You have the right to cancel your membership at any point, and by doing so, your personal information will be removed from our records. You can do this by contacting the Corporate Governance department on trust.foundation@ rmh.nhs.uk or by calling 020 7808 2844. If you have any queries or concerns, please do not hesitate to get in touch.
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PUZZLES & PRIZES
PRIZE CROSSWORD
The lucky winner of our prize crossword will receive a £50 John Lewis gift card. Send your crossword with your name and contact details to RM, PR and Communications Team, The Royal Marsden, Fulham Road, Chelsea, London SW3 6JJ. The entry closing date is Wednesday 1 August 2018. See below for prize draw rules. Spring 2018 crossword solution Across 2 Guinea pig 6 Koi 7 Gripped 8 Nieces 9 Mead 11 Gust 12 Voices 16 Unlatch 17 UFO 18 Sea breeze Down 1 Token 2 Gaiters 3 Ingle 4 Emir 5 Gadid 10 Exclude 11 Glues 13 Ochre 14 Shoal 15 Star Congratulations to Mrs PJ Harrison, the winner of the Spring 2018 issue’s crossword prize. 1
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Try the fiendishly tricky numbers puzzle – it’s just for fun
FOR THE ROYAL MARSDEN
4 5 9 1 1 6 7 4 9 6 5 8 6 3 4 2 5 1 5 4 1 3 9 5 2 3 5 9 6
6 5
Across 1 King or dictator (5) 4 Mother of pearl (5) 6 Breed of cat (7) 8 Water bird (4) 9 Big (5) 12 Claim to be false (5) 13 Animal’s nail (4) 15 Ancient Egyptian king (7) 17 Tree (5) 18 Walks through water (5)
Down 1 Go there and back (5,4) 2 Big cat’s baby (4,3) 3 Flower (4) 4 Almost (6) 5 Signal (3) 7 Mountain plant (9) 10 Sister, for instance (7) 11 Join together (6) 14 Arabian boat (4) 16 Consumed (3)
Fill in your details below when sending in your crossword competition entry. See above for details of our address. NAME ADDRESS
POST CODE
PRIZE DRAW TERMS AND CONDITIONS 1. The Prize Draw is open to all readers of RM except employees of the Press Office at The Royal Marsden and Sunday, who produce RM magazine. 2. The closing date for receipt of all entries is Wednesday 1 August 2018. Only one entry per person per draw. 3. Responsibility cannot be accepted for entries that are incomplete, illegible or not received. Proof of posting is not proof of receipt. No cash alternative is available and prizes are not transferable. Value of prize is correct at time of going to press. 4. Winners will be notified by post within 14 days of closing date.
Rachael Reeve Director of Marketing and Communications Elaine Parr Head of PR and Communications Abby Samuel PR and Communications Manager Catherine O’Mara Senior PR and Communications Officer Belinda Lock Senior PR and Communications Officer Hannah Bransden Senior PR and Communications Officer Jack Stonebridge Senior PR and Communications Officer
FOR SUNDAY Marc Grainger Editor Mark Wheeler Art Director Sian Purdy Designer Gill Tait Account Director Richard Robinson Group Editor Matt Beaven Creative Director Toby Smeeton Managing Director RM magazine is published by The Royal Marsden in partnership with Sunday: wearesunday.com
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SUMMER 2018 PRIZE CROSSWORD ENTRY FORM
TELEPHONE
THE TEAM
CROSSWORD CLUES
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SUDOKU
5. The Promoter’s decision on any aspect of the promotions is final and binding. No correspondence will be entered into. 6. The Promoter reserves the right to substitute a prize of equal or greater value should circumstances make this necessary. 7. Entry implies acceptance of rules. 8. The winner of the crossword prize of a £50 John Lewis gift card will be the first correct entry drawn out of the bag. 9. The Promoter is The Royal Marsden, 203 Fulham Road, London SW3 6JJ.
© The Royal Marsden 2018. All rights reserved. Reproduction in whole or part is prohibited without prior permission of the Editor. The Royal Marsden and Sunday accept no responsibility for the views expressed by contributors to the magazine. Repro by F1 Colour. Printed by Pureprint.
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S TAY I N T O U C H
COMMENT, LIKE, SHARE Join the conversation at twitter.com/royalmarsden twitter.com/royalmarsdenNHS facebook.com/royalmarsden Twitter
Holly Branson @HollyBranson I j ust had a wonderful tour of the @ royalmarsden [ right] . S uch a wonderful team of doctors, nurses and e ea c e a tin cance Dan @WSussexDan e mem e o taff t e e is amaz ing and the care and treatment they give is amaz ing. Thank s for helping m Da to contin e i t Hannah Couzens @HannahCouzens Thank you to the incredible team @ royalmarsdenN H S for saving my mum’ s life. I will never be able to express my true gratitude. You guys are actual heroes.
Nikki Parrott Thank s once again for another fantastic day! ! Couldn’ t be prouder of my two boys [ right] for com etin t ei t ma c in memory of someone special! ! A ll feeling a little achey today but it’ s worth it.
Deborah Bowman @deborahbowman The funny & k ind hostess on the chemo unit @ royalmarsdenN H S told me today that, lik e so many of t ei taff e a a att e to get to work , but “ had to be there for her patients who need feeding & hot drink s” . W onderful commitment.
Liz Fernandez This was my 3 rd Marsden March and I was really worried about whether I would manage it this year. I on ni e c emo ee ago and hadn’ t been able to do much walk ing. I had an amaz ing team, though, and we made it! Thank you to all the organisers and the lovely marshals – it was brilliant!
Dawn Holton It mak es me tearful and humbled when I think of how much k indness and care has been shown to me by this wonderful, wonderful hospital. They have saved my life and I am forever grateful. The Royal Marsden S utton is a very happy place for me. They are now my family.
CONTACT US CALL THE ROYAL MARSDEN, CHELSEA
020 7352 8171
CALL THE ROYAL MARSDEN, SUTTON
CONTACT THE ROYAL MARSDEN HELP CENTRE For confidential chat, support and information, call
020 8642 6011
0800 783 7176
VISIT US ONLINE royalmarsden.nhs.uk
or visit royalmarsden.nhs.uk/your-care/ royal-marsden-help-centre
WANT TO WORK AT THE ROYAL MARSDEN? Visit jobs.royalmarsden.nhs.uk READ RM MAGAZINE ONLINE royalmarsden.nhs.uk/rm-magazine
For general feedback, compliments, concerns or complaints, send us a message royalmarsden.nhs.uk/ contact-us/get-in-touch
STAY IN TOUCH WITH THE ROYAL MARSDEN CANCER CHARITY CALL US
020 8770 0279 EMAIL US charity@royalmarsden.org VISIT US ONLINE royalmarsden.org Registered Charity No. 1095197
Look out for the autumn 2018 issue of RM – coming September 2018 RM magazine 31
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Up for a challenge? We have many exhilarating events for you to take on, from cycling, trekking and running to open water swimming, parachute jumping and abseiling. Every pound you raise will ensure our expert nurses, doctors and research teams can provide patients with the very best care and develop life-saving treatments. Find out more at www.royalmarsden.org/challenge Registered Charity No. 1095197
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