Cancer is a significant part of the healthcare agenda in the NHS and the last 15 years has seen considerable reform and investment in screening, the organisation of cancer teams, cancer pathways and waiting times for treatment.
The cancer agenda is being driven forward by the Cancer Reform Strategy (2007) and its subsequent annual reports. In southwest London there are likely to be significant changes to the way cancer care is delivered, changes which St George’s Healthcare is keen to embrace.
These changes will undoubtedly focus more on the patient pathway and experience, on outcome and survivorship, and necessitate much greater integration between primary, secondary and tertiary care, ensuring that London is able to provide cancer services that are the equal of the world’s best. The trust’s cancer service is therefore preparing to meet the exciting challenges that are on the horizon.
The trust has for a long time played a key part in cancer prevention, offering screening services for southwest London and treatment for pre-cancer stages, and is building on its close relationships with primary healthcare teams and local hospices to provide seamless care for cancer patients.
St George’s Hospital is a cancer centre within the South West London Cancer Network. The trust provides all its cancer services to the local community and sees around 1,700 new cancer patients every year. We provide the majority of southwest London’s complex cancer surgery and also provide simple and complex chemotherapy.
Much cancer-related activity takes place in our outpatient department, and cancer-related bed-days make up 15% of the total trust admitted patient care workload. Cancer care at the trust is dependent on other services, such as surgical, anaesthetic, intensive care, pathology and diagnostics, so it is a significant benefit for patients to have them all on one site in Tooting, which has excellent public transport links.
St George’s has an extensive team of cancer-specific clinical nurse specialists (CNS). Each CNS holds a Macmillan title, making St George’s one of the largest Macmillan teams in England. In addition, St George’s Urology CNS has won CNS of the year for the past two years. During 2011 the Trust is also pleased to announce the opening of a Macmillan Information Centre.
Recently the trust has been awarded ‘Beacon site’ status for the pilot of Cancer Information Prescriptions, which means cancer patients will receive personalised information about their condition. St George’s also offers a range of support services for patients at the trust, including social, psychological, spiritual, complementary therapy and local community based cancer support.
The trust provides a full range of oncoplastic surgical procedures for both benign and malignant breast disorders. There is a well-established dual dye and radioisotope Sentinel Lymph Node Biopsy (SLNB) service which is now the standard of care for selected patients, with the aim of avoiding unnecessary axillary clearances.
Our advanced nurse practitioners have led on the development of breast diagnostic services and virtual clinics, a concept that is being considered by other providers. Our co-location with the South West London Breast Screening Service supports rapid diagnosis and a seamless transition along the patient’s care pathway.
Earlier in 2010 we announced the development of a brand new breast diagnostic unit, opening in 2011, which will provide state-of-the-art services for the diagnosis and treatment of breast cancer and other breast diseases. Recently St George’s has developed a 23 hour model of care for breast cancer patients, and due to the success of the model, the trust has been asked to present it at a national NHS Improvement event. The breast services at St George’s embrace service development to improve patient care and will soon be embarking on a pilot related to breast cancer patients undertaking self directed follow-up treatment, resulting in empowering patients and over time, replacing the traditional follow-up pathway.
The skin cancer and melanoma service at St George’s is the only dedicated service in the country. It is the hub of the network and the majority of patients from surrounding providers are sent to the trust. The service has a large catchment area of southwest London, Surrey, Sussex, Hampshire and West Sussex. St George’s cares for patients from a preventative aspect, supporting early diagnosis with rapid referral clinics and provides a seamless package of care for all patients, from diagnosis to end of life care.
St George’s urological cancer service is a regional centre for both common and rare urological cancers and holds joint operating sessions with consultants from Croydon, Epsom & St Helier and Kingston Hospitals, which smoothes referral pathways into the trust and maintains continuity for patients.
The urology team was one of the first in southwest London to introduce the innovative da Vinci robot, and is one of the only units in the country to offer all forms of ablative therapies for renal cancer in one unit. St George’s has the largest contemporary experience of penile cancer in the world. The penile cancer team, named National Oncology Team of the Year in 2009, is responsible for a catchment population of 10 million in the south of England.
Benefiting from direct links with on-site surgical specialities, including vascular, neuro, cardiothoracic, upper gastrointestinal, and ophthalmology, St George’s provides a comprehensive head and neck cancer service. The trust has been at the forefront of trying to improve community rehabilitation for these patients, post-treatment, with a discharge protocol agreed with primary care teams.
St George’s is the only trust in southwest London with a restorative dental service for pre-treatment screening, ongoing maintenance of dentition and oral rehabilitation following surgery. We are also the only trust in the network that runs a dedicated tracheostomy/laryngeal stoma clinic for ongoing care and long-term servicing of patient needs following surgery and chemoradiotherapy.
St George’s provides both diagnostic and specialist care for patients with cancer of the female genital tract. The latter includes diagnoses of ovarian, endometrial, cervical, vaginal and vulval cancer. The trust has the largest gynaecological cancer unit in the network, and we are also a designated cancer centre for gynaecological cancers. The service has particular expertise in vulval surgery, surgery for recurrent disease, fertility sparing surgery for cervical cancer and radical laparoscopic surgery, as well as expertise in ovarian and endometrial cancer. The service treats many high risk cases because of the trust’s intensive care facilities and other support services available on site.
All cardiothoracic surgery for patients in southwest London takes place at St George’s. The trust is a centre for interventional bronchoscopy, treating local patients, as well as acting as a tertiary centre for those throughout the network and beyond. At present, St George’s is the only hospital in the network offering radiofrequency ablation treatment to destroy local tumours in patients unfit for surgery or radical radiotherapy.
St George’s delivers a comprehensive service for lower gastrointestinal cancer offering expert diagnostic, surgical and oncological services. The trust is the regional centre for surgery for both advanced and recurrent colorectal malignancy and anal cancer surgery. Endoscopy services are provided in a state-of-the-art facility which is a national training centre. The Bowel Cancer Screening Centre for southwest London is also based at St George’s, which results in a seamless care pathway for patients.
A weekly ‘out of hours – open access’ rapid access proctology clinic is offered as an evening clinic for GP referrals; enabling patients to be seen rapidly and at a convenient time. The radiology department offers a comprehensive range of diagnostic and staging investigations meaning all these services are provided on site.
The neurological cancer service diagnoses primary and secondary tumours of the brain, as well as spinal, skull base and pituitary tumours. In association with a specialist neuroradiology unit carrying out imaging, using CT, MRI, including the state of the art 3 Tesla MRI scanner (3T), and angiography. The service also provides surgical treatment. St George’s is an inter-network specialist centre for neurosurgery and undertakes over 2,000 surgical procedures each year, using the latest surgical equipment, including frame-based and frameless stereotaxy.
Medical Oncology at St George’s is a large service, providing chemotherapy for a wide range of solid tumour and lymphoma patients. The trust’s Trevor Howell Unit has twelve day case chairs and three inpatient beds dedicated to chemotherapy administration. All chemotherapy is given by specially trained clinical nurse practitioners. In addition to day unit attendances the trust cares for a large cohort of patients on outpatient oral chemotherapy. The service benefits from specialist pharmacy support with a newly commissioned chemotherapy reconstitution facility. The trust is also currently looking into piloting the provision of chemotherapy in patient homes.
St George’s is a tertiary centre for children’s surgery, providing specialist abdominal, thoracic and urological surgery, as well as neuro, head and neck, plastic and gynaecological surgery for children with cancer. This care is provided in a child-friendly environment that has expert school and play therapy facilities, as well as dedicated operating theatres, children’s ward and Paediatric Intensive Care Unit (PICU).
The trust has expertise in the management of bone marrow failure disorders, immunohaematology, myeloproliferative disorders, myeloma, acute and chronic leukaemia, haemoglobinopathy and sickle cell disease. Specialist surgery, neurosurgery, renal, infectious diseases, medical specialty support and intensive care means that the haemato-oncology service is ideally placed to manage and treat complex and rare malignancies, including T-cell and HIV associated lymphoma. A number of nurse-led clinics and patient support groups are also provided to improve patient care and experience.
St George’s provides both diagnostic and local care for patients with cancer of the upper gastrointestinal (GI) tract, including radical medical oncology support for chemotherapy provision. Endoscopic ultrasound enables accurate staging of upper GI cancers and a team of therapeutic endoscopists support palliative management. There is a tertiary endoscopic retrograde cholangiopancreatography (ERCP) service for endoscopic diagnosis and palliation of pancreatic or hepatobillary tumours and radiofrequency ablation is available for hepatic tumours. The trust also runs an out-of-hours gastro-intestinal haemorrhage service.
75% of the trust’s palliative care team’s workload is committed to cancer patients and palliative care plays a significant part of the research and education programmes at St George’s. Following the implementation of the seven-day service in October 2009, St George’s became one of the first hospitals in the country to meet the out-of-hours service requirements. As a specific response to the End of Life Care Strategy (2008), the trust introduced an end of life discharge home service to increase the number of patients achieving their preferred place of death.
You can find out more about the cancer services offered by St George's on ourcancer services pages
Breast cancer secretary
Breast MDT co-ordinator
Breast CNS/key worker
Breast CNS/key worker
Skin cancer team
Skin MDT co-ordinator
Skin CNS/key worker
Melanoma CNS/key worker
Urology cancer secretary
Urology MDT co-ordingator
Urology(bladder/renal) CNS/key worker
Urology(prostate) CNS/key worker
Head and neck cancer secretary
Head and neck MDT co-ordinator
Head and neck CNS/key worker
Gynaecology cancer team
Gynaecology MDT co-ordinator
Gynaecology CNS/ key worker
Lung cancer secretary
Lung MDT co-ordinator
Lung CNS/ key worker
Haemato-oncology MDT co-ordinator
Lymphoma CNS/ key worker
Myeloma/leukaemia CNS/key worker
Lower GI cancer team
Lower GI MDT co-ordinator
Lower GI CNS/ key worker
Colorectal CNS/ key worker
Brain & CNS cancer team
Brain & CNS MDT co-ordinator
Brain & Central Nervous System CNS/ key worker
Trevor Howell day unit
Clinical nurse specialist
Paediatric cancer secretary
Paediatric cancer CNS/ key worker
Palliative care team
Palliative care secretary
Palliative care CNS
Upper GI cancer secretary
Upper GI MDT co-ordinator
Upper GI CNS/ key worker
News in brief
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