Private Care SPRING 2020
PACE OF PROGRESS How treatment advances are giving new hope to lung cancer patients Shaping the future of radiotherapy delivery
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SPRING 2020
LUNG CANCER AT THE ROYAL MARSDEN
THE FACTS
500+
new patients are seen each year by the Lung Unit at The Royal Marsden and the William Rous Day Unit at Kingston Hospital
WELCOME As the Managing Director of Private Care at The Royal Marsden, I’m pleased to introduce the latest issue of Private Care magazine. We have one of the leading radiotherapy departments in the country at The Royal Marsden. In this issue, we look at how our leading-edge technology and exceptional staff ensure that our patients can access the latest treatments and the highest levels of care. We also look at the work of The Royal Marsden’s Lung Unit, which has been making incredible advances in research and treatment for lung cancer, resulting in longer survival being the ‘new normal’ for many patients. Finally, we speak to Miss Jennifer Rusby, one of our consultants in the Breast Unit, about her work in reconstruction, improving the patient experience and minimising side effects for women with breast cancer. I hope you enjoy this issue. Shams Maladwala Managing Director of Private Care
3rd
most common cancer in the UK
44%
of people diagnosed with lung cancer in the UK are aged 75 or older
47,000
people are diagnosed with lung cancer in the UK each year
87%
of all cases are non-small-cell lung cancer, with small-cell lung cancer accounting for the rest
1 in 3
people live for at least one year after diagnosis. About one in 20 live for at least 10 years
ON THE COVER Dr Fiona McDonald, Consultant Clinical Oncologist
FIND OUT MORE
For referrals and enquiries, call 020 7811 8111 or email privatepatients@rmh.nhs.uk
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U P DAT E
QUALITY OF CARE Inspectors noted the kindness shown by staff to patients
TRUST RATED OUTSTANDING THE ROYAL MARSDEN has retained its ‘outstanding’ ratings as a Trust and for being well led, following inspections by the Care Quality Commission (CQC) in September and November 2019.
Inspectors commented on the collegiate and supportive culture, strong teamwork, and the quality, kindness and compassion of care given to patients across both Chelsea and Sutton.
Professor Ted Baker, England’s Chief Inspector of Hospitals, said: “The Royal Marsden NHS Foundation Trust is a beacon of outstanding practice. It was outstanding overall before, but has improved by achieving outstanding in four of the main categories that the CQC rates.” Dame Cally Palmer, Chief Executive of The Royal Marsden, said: “I would like to thank and congratulate all the staff for the exceptional quality of care they deliver for patients every day, which is reflected in the CQC’s rating of outstanding for the Trust overall. “Our patients can have confidence that they are receiving the very best treatment and care, and supporting us to improve survival for patients worldwide through research and innovative practice.”
TALKING POINTS “We’re beginning to turn on its head the notion that once lung cancer has spread, radical radiotherapy is not helpful”
“Our radiotherapy studies have changed the way cancer patients are treated, not only here but also across the country”
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“Those with little or no English really appreciate having someone present who can speak their language” Page 12
“For patients whose cancer is sensitive to drug treatments, the prospect of avoiding surgery altogether is close to reality” Page 14
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IN BRIEF
PUT TO THE TEST Professor Nicholas Turner
Prostate study
A team at The Royal Marsden and The Institute of Cancer Research, London is aiming to find out why men of African and Caribbean descent are diagnosed with prostate cancer at twice the rate of the overall UK average. Researchers on the PROFILE study will test the genes of these men to see if they can learn to predict prostate cancer risk, and find better ways of diagnosing and treating the disease.
Survey success
The Royal Marsden has been ranked among the top NHS trusts for patient experience for children and young people, according to a recent survey by the Care Quality Commission. All paediatric patients felt they were well looked after while in hospital, and The Royal Marsden scored above average in areas such as pain management, experience on the ward and communication with staff.
AI fellows
Two clinicians from The Royal Marsden are working on the latest research in artificial intelligence (AI) and lung cancer, looking at how the technology can be used for better diagnosis, treatment and care. Dr Benjamin Hunter was awarded a pan-London fellowship by West London Cancer Alliance RM Partners, while Dr Sumeet Hindocha is undertaking a PhD at Imperial College London.
LIQUID BIOPSY: THE BIG PICTURE A NEW ‘LIQUID BIOPSY’ test can identify rare mutations in advanced breast cancer, which may enable patients to access effective treatment more quickly in the future. Professor Nicholas Turner, Consultant Medical Oncologist at The Royal Marsden and Team Leader at The Institute of Cancer Research, London (ICR), presented findings from the plasmaMATCH trial at the international San Antonio Breast Cancer Symposium in Texas in December 2019.
The trial, which received support from the NIHR Biomedical Research Centre at The Royal Marsden and the ICR, and was largely made up of patients at The Royal Marsden, looked for mutations in the DNA from tumours shed into the bloodstream, and found specific weaknesses that could be targeted with drugs. Professor Turner said: “We have now confirmed that liquid biopsies can quickly give us a bigger picture of the mutations
within multiple tumours throughout the body, getting the results back to patients accurately and faster than we could before. This matters a lot in terms of making decisions, particularly for those with advanced breast cancer who need to be put on new treatments quickly.”
“Liquid biopsies quickly give us a bigger picture of the mutations”
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U P DAT E
New approach could improve chemotherapy effectiveness IN A WORLD FIRST, The Royal Marsden has treated a patient with state-of-the-art acoustic cluster therapy as part of a clinical trial. This pioneering treatment is an innovative new approach that uses microscopic clusters of bubbles and liquid droplets to enhance the delivery of chemotherapy drugs to tumours. Delivering acoustic cluster therapy is a cross-team effort, involving a radiologist, physicist and at least two nurses. One nurse is responsible for administering the chemotherapy the patient normally receives and, midway through, another will mix the bubbles and liquid droplets into microscopic clusters. These clusters are then injected into the patient along with the chemotherapy drugs.
At this point, a radiologist uses a standard ultrasound scan to convert the clusters into an activated form within the tumour. Once activated, with further ultrasound, the clusters help to ‘pump’ the drug into the tumour, greatly increasing the amount of the drug reaching the cancer cells. Professor Udai Banerji, Deputy Director of the Oak Drug Development Unit at The Royal Marsden and The Institute of Cancer Research, London, said: “It’s exciting to be involved in this unique project. This new therapy could improve the effectiveness of chemotherapy by better targeting the tumour, reducing exposure to the rest of the body, and hopefully lowering the rate and severity of treatment side effects.”
NEW YEAR HONOUR FOR CHIEF EXECUTIVE Cally Palmer, Chief Executive of The Royal Marsden NHS Foundation Trust, has been awarded a DBE for services to cancer medicine in the 2020 New Year Honours. Cally has worked for the NHS for her entire career. In her 21 years as Chief Executive, she has worked tirelessly to improve the quality of cancer treatment, care and research. Since 2015, Cally has also been the National Cancer Director for NHS England, leading the implementation of the National Cancer Strategy to help save and improve lives through early diagnosis, personalised medicine and equity of care. She is also a Trustee of The Royal Marsden Cancer Charity and a member of the Board of Trustees of The Institute of Cancer Research, London. Cally [pictured with HRH The Duke of Cambridge] said: “I feel incredibly fortunate to work for the NHS and to be surrounded by brilliant teams making great strides in progress for people affected by cancer. My role is simply to enable them, and all our staff, to do what they do best.”
DRUG DELIVERY Professor Udai Banerji is leading the Phase I trial
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THE NEW SURVIVORS With advances in targeted treatments, immunotherapy and new radiotherapy techniques, today’s lung cancer patients are doing better than ever – and getting on with their lives THERE’S A NEW population of patients at The Royal Marsden, the likes of which we haven’t seen before: lung cancer survivors. Progress in treating the disease – with targeted therapies, immunotherapy and new radiotherapy techniques – is moving at such a pace that, for the first time, patients are finding themselves navigating a ‘new normal’. Tom McKinley is one such patient. Diagnosed with stage 4 lung cancer in September 2011, he was told that, without treatment, he had just six to 12 months to live. He has since gone from trial to trial, and eight years on is doing well. Tom tested positive for the ALK gene mutation, and was given a drug treatment to target it. He says: “I’m now on my fourth targeted treatment. These drugs weren’t available at the time of my diagnosis – that’s how quickly research is moving. It’s about staying in the game long enough for something new to come through.” Making progress Patients with targetable mutations such as ALK now enjoy a better quality of life, 6 Private Care magazine
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LU N G CA N C E R
as well as more time before relapse, according to Professor Sanjay Popat, Consultant Medical Oncologist. “It’s rewarding to see so many patients doing better than ever,” he says. “Patients with lung cancer historically had chemotherapy, which made them feel extremely unwell and extended life by just a couple of months. Now we see more and more patients getting on with their lives.” Meanwhile, the HALT trial, led by Consultant Clinical Oncologist Dr Fiona McDonald, is investigating the role of radiotherapy in patients with known driver mutations who are being treated with targeted therapy. She says: “Some of these patients develop limited progression of their disease in a few places. We are investigating whether adding stereotactic radiotherapy can prolong the time that they derive benefit from targeted therapy.” Dr McDonald is also the Chief Investigator on the SARON trial, which is looking at whether adding radiotherapy to systemic therapy can benefit
LEADING THE CHARGE Lung cancer specialist Professor Sanjay Popat (left); Tom McKinley has survived stage 4 lung cancer for eight years (above)
patients with non-small cell lung cancer who have up to five sites of spread. “One day, we’ll find out whether radical radiotherapy to a number of disease sites can extend survival in metastatic disease,” she says. “We’re beginning to turn on its head the notion that once lung cancer has spread, radical radiotherapy is not helpful. Irradiating the primary tumour and other disease sites may give additional survival benefit over systemic drugs alone.” The immunotherapy drugs pembrolizumab, nivolumab and atezolizumab – which all harness the body’s immune system to attack cancer cells – have been approved to treat metastatic lung cancer in recent years. And thanks to the PACIFIC trial, we know that using the immunotherapy drug durvalumab following radical chemoradiotherapy can significantly extend overall survival. Early detection While most cases of lung cancer are diagnosed at a late stage, when caught early, the disease is curable. Professor Mary O’Brien, Head of the Lung Unit, says: “In the PEARLS study, we are looking to improve the surgery cure rate by using pembrolizumab after surgery, which should report results in the next 18 months. We’re also working with RM Partners, our local cancer alliance, to run a pilot study offering low-dose CT scans to people at high risk of lung cancer.” The outlook has never appeared better for patients, but we must not stop while a cure is in sight.
DR FIONA MCDONALD Consultant Clinical Oncologist Dr McDonald specialises in treating patients with all types of lung cancers across The Royal Marsden’s Chelsea and Sutton hospitals. She also leads on research and technological developments to improve outcomes for patients, ensuring that we remain at the forefront of radiotherapy technology. Dr McDonald’s research aims to improve patient outcomes by developing individualised approaches to lung radiotherapy through the integration of novel imaging and targeted biological agents with advanced radiotherapy technologies, including stereotactic/CyberKnife, intensity-modulated and image-guided adaptive radiotherapy. She is the clinical lead for novel developmental work on magnetic resonance-guided adaptive radiotherapy for lung tumours.
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RISE OF THE MACHINES The MR Linac is a key part of The Royal Marsden’s array of advanced radiotherapy equipment
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RADIOTHERAPY
LEADING EDGE The Royal Marsden is pioneering the latest radiotherapy treatments, with state-of-the-art machines such as CyberKnife and the MR Linac delivering significant improvements
HOME TO ONE of the largest radiotherapy departments in the UK, The Royal Marsden delivers more than 70,000 treatments a year, of which around 10,000 are for Private Care patients. Rated ‘outstanding’ by the Care Quality Commission, the radiotherapy service works in close partnership with The Royal Marsden’s academic and research partners to design, deliver and assess the latest techniques in order to remain at the forefront of international radiotherapy delivery. The techniques developed at The Royal Marsden have been rolled out across the country, and new treatment methods have been shared with more than half of the UK’s radiotherapy departments. Dr Susan Lalondrelle, Consultant Clinical Oncologist and Lead for Clinical Oncology, says: “At The Royal Marsden, we thrive on change and embrace it. We like to try new ways of doing things for the
benefit of our patients. Our radiotherapy studies have changed the way cancer patients are treated, not only here but also across the country.” With the arrival of a new CyberKnife machine at our Sutton hospital later this year, the Trust will have more capacity and scope to deliver advanced stereotactic body radiotherapy (SBRT). Using a robotic arm to support a linear accelerator (linac) head with an advanced multi-leaf collimated system, the CyberKnife can deliver larger doses of precisely targeted SBRT to moving tumours and very small brain tumours. The non-invasive treatment minimises damage to healthy tissue and is delivered with such accuracy that fewer treatment sessions are required, offering improved quality of life for all patients. This is the second CyberKnife to be funded by supporters of The Royal Marsden Cancer Charity, after the first was installed
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in Chelsea in 2011. The Royal Marsden was one of the first NHS hospitals to install the CyberKnife, which has since treated nearly 3,000 patients and been the focus of international research. Study success Recent results from the PACE-B trial suggest that this advanced radiotherapy technology could safely deliver curative treatment for some prostate cancer patients over a shorter period. Led by Dr Nicholas van As, Medical Director and Consultant Clinical Oncologist at The Royal Marsden, and Reader at The Institute of Cancer Research, London, researchers used the CyberKnife to deliver five higher doses of radiation to patients over one to two weeks. They found that, in the three months after treatment, the
side effects were no worse than those in patients who had the conventional therapy of lower doses over a longer period. Dr van As says: “We are focused on developing smarter, better and kinder treatments for patients across the UK and internationally. Developments in radiotherapy such as SBRT mean we can target tumours much more effectively. Using SBRT to deliver this treatment would mean that patients could be spared numerous visits to hospital, allowing them to get back to their lives sooner.” In September, The Royal Marsden reached the milestone of treating patients with the MR Linac for one year. This pioneering type of radiotherapy combines two technologies – an MR scanner and a linac – to precisely locate tumours, tailor the shape of X-ray beams in real time, and accurately
WORKING SMARTER Dr Nicholas van As led a trial using the CyberKnife to treat prostate cancer patients more quickly
deliver doses of radiation to moving tumours. We became the first centre in the UK – and only the third in the world – to use the revolutionary machine in September 2018, treating prostate cancer patient Barry Dolling as part of the PRISM trial. Our multidisciplinary team of clinical oncologists, physicists and therapeutic radiographers have since delivered 600 treatments to almost 50 patients with prostate, rectal, bladder, cervical and ovarian cancers, and recently treated a head and neck tumour for the first time. The MR Linac allows us to see the anatomy in greater detail at the time of treatment and so adapt the radiotherapy plan accordingly each day, explains Dr Lalondrelle: “The progress we have made in the past year has been exceptional. We are working towards using the imaging quality and real-time image acquisition to improve the pinpoint accuracy of treatment in fewer sessions and with less toxicity. For some tumour sites, the MR Linac has enormous potential to transform the way we treat cancers and significantly improve patient outcomes.” Well equipped In addition to the CyberKnife and MR Linac, a total of 14 linacs across Chelsea and Sutton enable The Royal Marsden to deliver all forms of advanced external-beam radiotherapy. Sutton has three of the newest Elekta Versa HD machines, while in Chelsea, there are three of the latest models of the Varian TrueBeam, costing about £2.3 million each.
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RADIOTHERAPY
DR SUSAN LALONDRELLE Lead for Clinical Oncology
The TrueBeams can treat up to 40 patients with breast, lung, head and neck, prostate, gastrointestinal or gynaecological cancers every day. They also feature an advanced flattening filter-free delivery system, which means the treatment dose can be delivered more quickly. Also, the high dose rate (HDR) brachytherapy suite at Chelsea provides the latest MR-guided adaptive treatments for gynaecological cancers using an internal radiation
“At The Royal Marsden, we thrive on change and embrace it”
technique to escalate dose, which is proven to improve cancer control. Sarah Helyer, Radiotherapy Services Manager, says: “Developments in imaging allow us to target tumours with sub-millimetre precision. Greater accuracy means fewer healthy cells are damaged, which, in turn, means higher doses can be given. This makes treatment more effective and reduces side effects. “Our unit aims to continue to improve radiotherapy treatment and be at the forefront of radiotherapy delivery in the UK and internationally for the coming decades, offering new techniques to patients and training the next generation of radiographers and researchers who will shape the future of cancer treatment.”
TAKING THE LEAD Advances made at The Royal Marsden are rolled out across the UK, says Dr Susan Lalondrelle
Dr Lalondrelle is a Consultant Clinical Oncologist specialising in the treatment of gynaecological and skin cancers with radiotherapy, brachytherapy and systemic therapies. She is also the Lead for Clinical Oncology at The Royal Marsden. Dr Lalondrelle is actively involved in clinical research, leading a portfolio of trials in advanced radiotherapy techniques including SBRT, MR-guided radiotherapy, image-guided radiotherapy, and adaptive planning and image-guided brachytherapy in gynaecological cancers. Her research focuses on individualising treatment delivery to minimise toxicity. She also has a strong interest in the combination of radiotherapy with novel systemic therapies including immunotherapy, and the role of circulating human papillomavirus (HPV) DNA in assessing response to treatment. Dr Lalondrelle is the international lead for gynaecology in the MR Linac Consortium and a member of the National Cancer Research Institute’s Gynaecological and CTRad clinical study groups.
For referrals For referrals andand enquiries, enquiries,call call 020 020 7811 78118111 8111 oror email email privatepatients@rmh.nhs.uk privatepatients@rmh.nhs.uk RMPC27_p08-11_Radiotherapy_v2.2.indd 11
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GOING THE EX TR A MILE Our international team offers clinical and cultural support to patients from around the globe who come to The Royal Marsden for world-renowned treatment. We meet some of the team and the patients they’ve helped
With a patient population spanning more than 60 countries, The Royal Marsden has a dedicated international team committed to supporting patients throughout their treatment. The team of advocates, translators and co-ordinators can help with all aspects of medical care, including choosing the right consultant or treatment, arranging appointments and admissions, assisting with payment and billing enquiries, arranging accommodation, and providing emotional support. They also offer translation services for many languages, including Arabic and Mandarin, and The Royal Marsden website has recently been translated into Russian.
FIND OUT MORE
Contact the International Patient Centre on +44 (0)20 7808 2063 or int@rmh.nhs.uk *Name has been changed
Becky Bao
International Agency Manager “We understand how important it is for patients to feel settled at The Royal Marsden, especially when they have travelled so far from home and their families. We support Chinese-speaking patients and are a constant source of contact between them and the clinical
teams, helping them understand what their consultants have advised and, importantly, interpreting symptoms and feelings back. Those who have little or no English really appreciate having someone present who is able to speak their own language.”
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I N T E R N AT I O N A L T E A M
Laura*
Cervical cancer patient “I was originally diagnosed in Beijing, but chose to come to The Royal Marsden. My first impression was surprise at how different the atmosphere is compared to China. I was impressed with how the process is done at The Royal Marsden. In my hospital at home, the same procedure was done with much less privacy and less communication, because of the sheer volume of patients who are being treated. I felt nervous and helpless before, but at The Royal Marsden I could have my family beside me for support, along with the consultant and nurse who went through every detail with me.”
Khola Habeb (pictured, centre)
Arabic Advocate Service “We deal with referrals from Middle Eastern countries, and work directly with embassies and self-funding patients and their clinicians. We have a lot of patients travelling to The Royal Marsden from all over the world; as a renowned specialist cancer hospital, this number continues to increase – so it’s important we can offer support for patients in terms of treatment and care, but also from a cultural perspective. As the patient’s first
point of contact throughout their treatment, I offer both practical and emotional support, helping them with everything from translations and appointments to just being there to make them feel at ease.”
“As the first point of contact, I offer practical and emotional support”
Salem al-Nashi
Rectal cancer patient “I came to The Royal Marsden in October 2018 after being diagnosed with rectal cancer. Everything went smoothly and I believe how I was treated – with individual care and attention – helped my healing process. It was helpful to have my brother with me, and being treated in London meant that when
I was feeling better, I could visit the city. Throughout everything, I have been amazed by the medical and personal care I have received, and my genuine appreciation goes to all the health team, doctors, nurses and staff. At The Royal Marsden, they don’t just treat cancer, they treat the whole patient.”
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MISS JENNIFER RUSBY Consultant Oncoplastic Breast Surgeon MISS JENNIFER RUSBY is one of the leading breast cancer surgeons at The Royal Marsden. She graduated from the University of Oxford in 1998 and trained at Wessex from 2000 to 2005 before working in the USA and Birmingham. Miss Rusby was appointed as a Consultant Breast Surgeon at The Royal Marsden in 2010. She has been a Reader at The Institute for Cancer Research, London since October 2019, and is a Health Foundation Generation Q Fellow in Leadership and Quality Improvement.
Miss Rusby’s research interests aim to enhance the patient experience and achieve better results. Her research is characterised by seeking patients’ opinions about what matters to them, organising research engagement meetings and working with patients to develop studies that answer patient-centred questions. One of her recent studies focused on three-dimensional surface imaging to show patients how they might look after surgery. The technology is likely to be rolled out into standard practice soon.
CAREER HIGHLIGHTS 1998 Graduates from University of Oxford 2000-05 Surgical training at various NHS trusts in Wessex 2005-07 Research fellowship at Massachusetts General Hospital in Boston, USA 2007-08 National Oncoplastic Fellowship at University Hospitals Birmingham NHS Foundation Trust
Q&A 2008-09 Oncoplastic Breast Surgical Fellowship at The Royal Marsden 2010 Appointed Consultant Breast Surgeon at The Royal Marsden 2019 Made Reader at The Institute of Cancer Research, London 2019 Made Health Foundation Fellow in Leadership and Quality Improvement
Q How have surgical techniques for breast cancer changed during your career? A The focus in the past decade has been towards maintaining excellent levels of cancer control while minimising treatment side effects. Techniques to facilitate breast-conserving surgery – either surgical rearrangement and reshaping, or the use of medical treatments
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C O N S U LTA N T F O C U S
“Research designed to pinpoint breast tissue that needs to be removed while preserving healthy tissue will come to fruition”
to first shrink the cancer – have become standard practice. For patients whose cancer is particularly sensitive to drug treatments, the prospect of avoiding surgery altogether is close to reality, while for those who do require a mastectomy, reconstruction techniques are continually evolving. The latest advances include acellular dermal matrix – which is a material to support and maintain the position of an implant – and lighter silicone implants.
Q What services do you provide at The Royal Marsden? A We offer a ‘one-stop’ diagnostic service, where patients see a clinician and have imaging and biopsies carried out during the first appointment. Many women have a benign problem and can be reassured that they don’t have cancer, while those who do will have immediate contact with a clinical nurse specialist. Their case will be discussed in a multidisciplinary meeting so that a treatment plan can be tailored to their needs. We offer the full spectrum of surgical procedures, working with plastic surgery colleagues where required, with onward referral to the medical team for additional treatments.
be running a feasibility study called PIONEER, encouraging women to change aspects of their lifestyle towards reducing their risk of breast cancer.
Q Which areas of research are you involved in? A My research falls into three main categories. The first is using modern imaging to inform patient choice: I have been working with several devices that produce a three-dimensional surface image to better predict appearance after surgery. The second area is tumour localisation: as a team, we have been evaluating new devices to pinpoint the location of small tumours at the time of surgery. My third research interest is lifestyle and breast cancer prevention: we will soon
Q What is special about the service offered at The Royal Marsden? A The Royal Marsden Private Care offers rapid access for diagnostic assessment, so that even if you don’t think you have breast cancer, you can get that reassurance quickly. For those with cancer, we provide personalised, multidisciplinary treatment with support from breast care nurses. Unusually among private care providers, our profit is reinvested into the hospital, thereby improving our services across the board and enabling us to give all of our patients a better experience.
Q What does the future hold for breast cancer treatment? A Some women will avoid surgery altogether, either because their cancer can be obliterated using radiological techniques or because of developments in tailoring drugs to individual cancers. For women requiring surgery, research designed to pinpoint breast tissue that needs to be removed while preserving healthy tissue will come to fruition so that removal is more accurate and complete, and has fewer side effects.
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As Europe’s largest cancer centre, The Royal Marsden has the expertise, facilities and technology to provide the highest standards of personalised care, and we treat more private patients than any other UK centre. By choosing The Royal Marsden, you are ensuring the best possible treatment and care, at the moment a patient needs it most. Because where a patient goes first really matters.
Life demands excellence
To refer a private patient, contact our Central Referral and Information Line on +44 (0)20 7811 8111 or email privatepatients@rmh.nhs.uk royalmarsden.nhs.uk/private
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