COVID-19 latest updates

October is Breast Cancer Awareness month and with it comes our duty as clinicians to raise awareness amongst women who may be concerned about a suspicious breast lump or breast changes, to present to their doctor and get an early diagnosis.

1 in 8 women are diagnosed with breast cancer and with the incidence increasing in premenopausal women who are not eligible for breast screening, it is incredibly important to get an early diagnosis.

Treating breast cancer early can lead to better clinical outcomes and increase the chance of a cure. At GenesisCare, we pride ourselves on delivering end to end care for patients. All patients can access diagnosis to treatment through investment in 5 One Stop Breast diagnostic hubs at our centres in Cambridge, Oxford, Milton Keynes, Windsor and Maidstone.

Men can get breast cancer too and again, early diagnosis and treatment is more likely to lead to cure, so now it’s time for everyone to raise awareness, promote self-examination and educate the public how to access our facilities at a time when they need it most.

At GenesisCare, we want to continually improve and innovate our service for patients and referring doctors. As an example, our patient survey scores are 90 and above as a result responding to the valuable feedback we receive.

Now it’s time to understand how we can improve our service from your perspective. We would be very grateful if you would take this simple 3 minute survey designed for doctors to help us offer the very best care we can to your patients.

Take the 3 minute survey

Project Cornerstone and Global Quality transformation
Our global journey to improve our quality and refocus on governance is now in full swing, thank you to those who have contributed and continue to support the new governance structures in the UK.

What this means for the UK is a greater involvement of clinical leaders in the governance, research, quality and innovation aspects of the business, more accountability from governance and clinical committees and improved greater patient and clinician experience.

The re-introduction of the Clinical Leaders Forum and the development of a new UK Research Governance Committee, chaired by the Research Physician Director reporting into the Global CMO are two very important elements of the new governance structure. Once the Research Physician Director role is filled, they will work at a local level with the broader UK leadership team.

Horizon RO Portal
The fantastic work by Gary Bee, our IT Innovation Lead and his team, has made the Horizon RO Portal one step closer to being finalised. A lot of you have helped us by testing the portal and providing feedback which has helped us to make necessary refinements to the system. You will soon be able to use the portal to routinely book your patients directly into our systems and prescribe your patient treatment pathway in one go. This will reduce the time you currently spend doing admin work, will improve data governance and minimise errors.

Practising privileges, scope of practice and employers procedures
At GenesisCare, we always strive to maintain our clinical standards and we appreciate that your work and working schedules may have changed during this pandemic.

We understand that you may have temporarily taken on more clinical roles and treat additional tumour sites to your usual scope, for some of you this may become a more permanent arrangement. In addition, some of you may have had to change scope of practice altogether.

It is important that you let us know straight away of any change to the scope of your practice in order to avoid unnecessary patient delays when you come to refer a patient for treatment.

To ensure that GenesisCare is up to date with these changes in your working circumstances and in order to support you in the future with training and credentialing course’s pertinent to your scope of practice, we require you to complete the ‘Scope of Practice update’.

Download the Scope of Practice update

Sometime ago, we also circulated the Employers Procedures through a secure email, OneSpan, which asked you to read and sign. This is for all referrers / practitioners and not limited to clinical oncologists only, everyone who works in oncology needs to be aware of individual roles and responsibilities within the business.

If you have not read and acknowledged your understanding of the document can you please ensure you complete this. Should you require another email please contact practisingprivileges@genesiscare.co.uk

CMA – Article 22 requirements update
You will all know that consultants need to comply with the requirement to provide fee information to private patients under Article 22 of the Competition and Markets Authority’s Private Healthcare Market Investigation Order 2014 (the CMA Order) and to declare vested interest.

Requirements:

• Consultants must provide private patients (self-pay or insured) with letters containing fee information at two stages in their treatment pathway 
• Issued prior to outpatient consultations
• Subsequent letters must be issued prior to further treatment or tests

Must contain

• Your initial consultation fee
• Your follow up consultation fee
• Details of any financial interests you have in the medical facilities and equipment used at the hospital / clinic
• A list of all insurers that recognise you
• A statement encouraging insured patients to check their policy with their insurer regarding level and type of cover
• Standard statement issued by PHIN

GenesisCare obligations

• Private providers are required to ensure compliance with the CMA Order, which is a condition of our practising privileges

A complete set of guidelines and documents are available. Should you need any further support please contact your Centre Leader.

Covid-19 information

We continue to tackle the pandemic challenge by providing our local teams with adequate PPE, following the latest infection prevention and control measures which suggested healthcare workers wear visors as well as surgical masks and by screening and swab testing staff and patients almost on a weekly basis.

As with the first wave of the pandemic we welcome patients who have tested positive. If urgent are well to be treated, we will apply the following measures:

• Radiotherapy and diagnostic patients are scheduled at the end of the day
• On arrival patients are provided with a waterproof surgical mask
• Staff contact with patients are kept to a minimum and full PPE is worn by staff
• Patients are not held in a waiting room but escorted directly to the department
• Theranostics patients are escorted to the allocated isolation uptake room
• Once treatment is complete patients leave the centre immediately
• Continual disinfection of all hard surfaces
• Cleaning contractors are made aware and room cleaned at earliest opportunity
• Room remains out of service until full cleaning has occurred
• All staff are confident about the procedure for donning and doffing PPE

The above measures have prevented viral spread in our centres and we have now introduced a monthly COVID-19 audit to ensure compliance to those and other measures by all staff.

Patient testing is timed prior to each chemotherapy or Theranostics cycle and at the time of the pre-treatment blood test. For radiotherapy patients, COVID-19 testing is timed at the time of the CT planning appointment and patients are advised to self-isolate if possible between CT and treatment. Once radiotherapy has started, patients are tested on a weekly basis in case of protracted regimes (>2 weeks).

Research updates
A refreshed research strategy for GenesisCare UK has been agreed to reflect our new Site Management Organisation structure and our partnership with our Global GenesisCare Contract Research Organisation.

What that means for our business and yourselves:

• Expansion of the GenesisCare research and clinical trial portfolio over the next 18 months to align with our strategic direction which includes expansion into Theranostics, Medical Oncology, Radiotherapy, Real World Data Research
• Continue to leverage the mature Haematology research capability in the UK to attract phase II-IV commercial studies of clinical value
• Leverage our UK University partnerships to expand research into areas if there is a high clinical need unmet
• A new UK Research Governance Committee which brings our Clinical Reference Groups closer to our business operations and is accountable for new Research studies and Research performance
• Expansion of the research team to include a new Research Manager for UK who will drive the research portfolio and engagement

Integrative oncology
The past 2 weekends GenesisCare supported the  Yes to Life Integrative Cancer Care Charity delivering two fantastic educational events called Yes to Life 2020.

At GenesisCare, we fully support and recognise the vital role of a whole life approach and more than 95% of our patients now access wellbeing services as part of their integrative care pathway.

Our services include:

• Counselling
• Reflexology
• Acupuncture
• Relaxation
• Meditation
• Exercise clinic
• Nutrition

We are pleased to announce a Penny Brohn wellbeing support will now support patient in GenesisCare, Birmingham from this month.

This month we are celebrating our global purpose and GenesisCare values which times well with our recent expansion in the US and the integration of 300 centres and clinics into one global dream team.

Across the world, we now have more than 440 centres offering the latest treatments and technologies that have been proven to help patients achieve the best possible outcomes. For radiation therapy, that includes 300 centres in the US as well as 14 centres in the U.K., 21 in Spain and 36 in Australia. Every year our team sees more than 400,000 people globally.

Our purpose is to design care experiences that lead to best possible outcomes. You are familiar with the following values we all live and breathe. We are proud to have launched our 5th value, integrity always.

Integrity Always
We do the right thing for our patients, our partners and each other.

We make evidence-based decisions and take every action and face every challenge in the best interests of our patients and each other. We build trust and lead by example by acting in a safe, honest and transparent way, and call out when things are not right.

Biosimilar policy and new biosimilars
GenesisCare supports the adoption of biosimilars for all new patients. You can find our Biosimilar Policy below.

Download the biosimilar policy

Pfizer has launched bevacizumab biosimilar Zirabev in the EU and UK last month, it is currently the first and only bevacizumab biosimilar that has being launched. MSD will be launching theirs in the next 3 -6 months’ time. Zirabev was approved by FDA last year and is being used in the USA.

Initial review of the license indication of Zirabev compared with Avastin covers all indications except in combination with erlotinib and paclitaxel in the ovarian.

We are supporting the adoption of Zirabev at GenesisCare and this is now available for you to prescribe on iQemo.

DPD testing
GenesisCare has adopted DPD testing for every patient prior to starting 5FU based chemotherapy at GenesisCare and we will automatically request the test once we receive your referral.

The turnaround times for the test is 48 hours and therefore will not impact on patients starting treatment promptly. We will communicate the results to you as soon as they become available.

If you have a patient who urgently needs to start on chemotherapy and cannot wait for the test, you need to document the reasons very clearly and consent the patient on the risks of DPD toxicity.

Clinical Advisory Team (CAT) process
We have revised the CAT criteria for patient peer review eligibility in order to make the referral to treatment process more efficient and improve your engagement with local teams.

A patient case will automatically be referred to the CAT (Radiation Oncology and Medical Oncology) only in the case of a non-standard protocol (which you know as ‘concession’ in the NHS).

The change that we have made is to remove ‘re-irradiation’ and ‘treatment overlap’ as criteria for CAT referral. Those cases remain complex and require a two-way conversation between practitioners and local physics and dosimetry teams.

As always, please send us your feedback and improvement suggestions to James or myself.

James McArthur
General Manager – UK

Dr Penny Kechagioglou
Chief Medical Officer – UK

Today we’re joining others globally to acknowledge World Patient Safety Day and on behalf of the GenesisCare UK team, I would like to emphasize the importance of keeping ourselves and our clinical teams safe so that we can continue to deliver the best possible outcomes for patients whilst maintaining safety and quality. 

During this week, we’ll be joining our colleagues globally to celebrate our achievements during the pandemic period, continuing to strengthen our patient safety agenda over the coming months.

Our patient survey results from August 2020 and last 3 months represent a true reflection of how much patients value their care experiences at GenesisCare.

All patients felt that they have been treated with dignity and respect in our centres and the overall care has been rated as excellent.

Our local teams have created a safe environment during the pandemic period which has enabled patients to feel confident coming for treatment at GenesisCare centres. We have worked with our clinicians to find ways to enable patients to have their diagnosis and treatment at the right time following the safest pathway.

Below are some of the values and behaviours that kept our teams resilient and patients safe.

• Integrity and respect 
  - Offered patients more choice, found new ways, respected patient choice 
• Working together 
  - Multidisciplinary decision-making, virtual business and training meetings, Telemedicine 
• Flexibility in treatment plans 
  - Adopted new clinical protocols and pathways and adapted existing ones
• Transparent discussion and support decision making 
  - Risks/benefits of treatment and clinical trials offered in case of limited treatment choices
• Keep safe during pandemic 
  - Viral testing protocol, patient and staff protection, knowledge transfer

GenesisCare is the only healthcare provider in UK which has implemented routine asymptomatic staff testing for SARS-CoV-2 on a weekly basis, which has been running now for 5 months. We’ve also been testing patients prior to starting each cycle of chemotherapy and prior to radiotherapy and invasive procedures. We have absorbed the costs as it was the right thing to do to keep our staff, doctors and patients safe.

We are committed to continuously apply preventive and protective measures as we go through the second phase of the pandemic. We’ll continue to keep you informed at all times of any changes in our processes, policies and clinical protocols. 

GenesisCare in Oxford – our main research hub – has continued essential life-saving clinical drug trials during the pandemic, led by our dedicated on-site clinical and research team. We currently have 2 haematology clinical trials open at Oxford with a third one opening soon.

GenesisCare in Cambridge is our new research hub and has recently recruited 3 patients in its first haematology clinical trial.

GenesisCare in Windsor will soon become our third research hub with the addition of a Theranostics clinical study to our portfolio of trials in UK.

Your are really keen to hear your views about how best to shape research and clinical trials at GenesisCare UK over the coming months, we would welcome any thoughts you have – please access the survey here or alternatively you can discuss further with Penny Kechagioglou:

Penny.Kechagioglou@genesiscare.co.uk
07583452198

During lockdown, GenesisCare UK has implemented a whole organisation approach to change resulting in considerable Quality Improvement in the structure and function of our Governance Committees as well as our operating procedures.

What does this mean for you and your clinical practice at GenesisCare:

• More efficient and safer booking processes paving the way to a digitised patient pathway based booking through Horizon RO portal in the near future
• Access to your data for the purpose of clinical audits and service improvement studies
• Tighter controls on virtual tools and Telemedicine to keep you and your patients safe
• Access to your performance metrics and dashboards for the purpose of your appraisals
• Access to a number of different eMDTs at GenesisCare for discussion of your routine and complex patient cases

Over the next few months, we will be embarking onto a Global Quality Improvement journey to align our operational and governance practices globally, as well as giving you the opportunity to collaborate with your peers globally through the various clinical reference groups and clinical leaders forums.

NHS England has made the executive decision to allow consultant appraisals to restart and they have sent a letter to all Responsible Officers in England to say that appraisals should commence in October and be completed by the 1st of April 2020.

Read the appraisal letter from NHSE 

Its great to see all the innovative work that has continued to develop in our centres and how this will improve the journey all our patients.

Elstree
The team at Elstree have been trained on, and are now using, 3D scanning to produce lead masks for facial skin lesions. The results have been amazing, they are all a great fit and so much easier for the patient, there is no alginate and plaster!

We will soon have the equipment in the centre for Photobiomodulation Therapy for our head and neck cancer patients. Two radiographers within the team have received their training and a third will be trained in November. This treatment has proved extremely successful in our Southampton centre, so we are excited to be able to offer this to our patients in the near future.

Chelmsford
Building work is underway for the construction of the Exercise Clinic. This is scheduled to continue for another three weeks and we are aiming to launch this service to all our patients from October. Our Penny Brohn Wellbeing Consultants are back in the centres. Currently we can only offer relaxation and mindfulness within the centres but are hopeful that counselling will be available from October. Counselling currently remains available to patients as a remote service.  All patients and staff are Covid swab tested weekly, making our centres a safe environment for all who attend. Together with the centre staff, we’re happy to answer any questions you may have and look forward to when we can get back to some normality following the Covid pandemic.

Georgina Grant, Centre Leader – Georgina.Grant@genesiscare.co.uk

CIEDs fall into two categories: Pacemakers (PMs – prevent bradyarrhythmias) and Defibrillators (ICDs – treat tachyarrhythmias).

• We treat non-pacing dependent patients with PMs, where the patient’s intrinsic or escape rhythm is enough to sustain adequate blood pressure. The total cumulative dose to the PM should always be kept <2Gy and includes the dose from CT planning scans and CBCTs
• We don’t treat pacing-dependent patients due to the risk of deactivation and patient decompensation
   

ICDs must be deactivated during radiotherapy using a magnet, with the patient being monitored through continuous ECG during treatment. This enhanced monitoring can only be done by a trained cardiac technician.

• We do not routinely treat patients with ICDs in our centres due to the lack of available cardiac technician support
• We are now exploring some local collaboration with cardiac units at the Cromwell and Milton Keynes in order to be able to expand our treatments to more patients

We have successfully treated our first patient with a cardiac ICD at our Milton Keynes centre supported by a cardiac technician on site. Our patient was in urgent need of spinal radiotherapy for pain control and the local team at Milton Keynes found the way to treat the patient safely through collaboration with the local cardiac unit.

The Covid-19 pandemic has disrupted the standard breast cancer pathways leading to fewer women presenting to their doctor with breast symptoms.

The Global breast cancer burden is increasing with more cases of pre-menopausal and post-menopausal Breast Cancer seen worldwide today than ever before.

The breast cancer challenge is the increasing incidence of advanced breast cancer in young pre-menopausal women who have not reached the breast screening age yet.

Breast screening is now being re-introduced slowly after the first wave of the pandemic, but will take time to reach normal capacity and the demand for two-week wait clinics is increasing.

At GenesisCare, we feel it is our duty to ensure an easy and affordable access to diagnostic facilities, hence the set-up of One Stop Breast clinics in Cambridge, Milton Keynes, Windsor and Maidstone. Our breast diagnostic hubs have supported patients getting access to the right treatment early by facilitating early cancer diagnosis.   

We offer all breast radiotherapy protocols and techniques to serve all patient needs including:

Standard fractionation 40Gy/15# and Simultaneous Integrated Boost 48Gy/15#
Hypofractionation 26Gy/5# with or without boost
Standard fractionation with SCF ± IMC ± axilla VMAT planning
Partial breast irradiation

We continued to apply Deep Inspiration Breath Hold for all left breast cancers throughout the pandemic, with SGRT and IGRT support and we will soon be extending our DIBH offer to all patients with right breast cancers, thus minimising liver and lung doses further.

View the GenesisCare UK breast cancer radiotherapy protocol here

Stay tuned for other breast cancer innovations which are soon to be introduced at GenesisCare.

Genomic pathway
Personalised imaging surveillance
Advanced Breast Practitioner
Planning Automation
SABR for primary Breast cancer and Oligometastases

Our Urology Hub has succeeded in performing 100 cystoscopies over the last 3 months.

Our prostate radiotherapy regimes have expanded during the pandemic according to individual patient needs, comorbidities and choice to include:

Standard 60Gy/20# for intermediate and high-risk patients
74Gy/37# for fit high-risk patients with pelvic nodes
36.25/5# for low – intermediate risk patient on our MR Linac facility

We have continued to support the treatment of advanced and metastatic prostate cancer through access to PET-CT/Gallium PSMA staging and subsequent Lutetium PSMA treatment (Theranostics) at our GenesisCare Windsor centre.

Patients with metastatic prostate cancer now have a safer and better tolerated treatment than chemotherapy and hormones with Theranostics introduced much earlier in their treatment pathway.

 On top of reaching a huge milestone in our MR Linac service last week, treating our 100th patient at our Oxford site, we are honoured and proud of the GenesisCare UK collaboration with the University of Oxford, ViewRay and the GenesisCare Foundation in Australia which together have offered free access to SABR treatment for NHS patients with pancreatic cancer on our MR Linac. The Compassionate Access Programme (CAP) aims to improve life outcomes for those patients with hard to treat pancreatic tumours, extending their life and improving their quality of life.

Benign conditions such as Dupuytren’s contracture and Plantar Fasciitis can be very debilitating for patients, whereas Keloid scarring can be unsightly for some.

More patients at GenesisCare can now have access to radiotherapy for benign disease our Cromwell site in London is now ready to accept referrals.

View more details on how to refer for benign diseases

As always, please send us your feedback and improvement suggestions to James or myself.

Kind regards,

James McArthur – General Manager UK

Penny Kechagioglou – Chief Medical Officer UK

I hope that you are enjoying some well-deserved time away after what has been an extraordinary first half of the year.

The teams at GenesisCare are looking forward to welcoming you back and working together on some exciting projects that are unfolding in the next year and within the context of the Service of the Future version 2.0. Outlined below are some of these exciting projects,and we would welcome your involvement in these great initiatives. If you’re interested, please get in touch with either James or myself.

The GenesisCare e-MDT Solution

Many of you have already been involved in the roll out of the e-MDTs for breast, prostate, neuro-oncology/SRS, SABR, haematology and head & neck. We are fully focussed on continuing the roll out to further locations and also exploring more specialities to develop this service for the future.

Interested in exploring this solution for your speciality? Please contact the team at mdt@genesiscare.co.uk

GenesisCare is the only independent provider to offer a secure platform-based e-MDT solution which includes an organised data repository, MDT coordinator support, a clear and concise MDT outcome and peer review report that can be shared with patients and primary care to ensure continuity of care.

Our e-MDT solution not only assures we are compliant with the CQC requirements for cancer MDT report provision for all cancer patients, but also reduces the burden on NHS MDTs and connects clinicians together from across the GenesisCare network nationally and globally.

HorizonRO Portal

Our Innovations team are building a global oncology and patient portal, called Horizon, to better empower patients and offer an extended experience that complements the care we provide in our centres.

Our ambition is to create a digital experience that provides trusted content, a better treatment journey and tailored care services to our patients, to improve outcomes and wellbeing.

We are now pleased to announce our initial pilot of HorizonRO is scheduled for 20th August 2020. This pilot will involve 5-10 Oncologists referring and prescribing for breast radiotherapy.

The pilot will last 2-3 weeks. We will then on-board additional Oncologists prescribing breast radiotherapy and then begin work on releasing palliative and urology care plans.

Get involved with our exciting HorizonRO portal! For more information reach out to James or myself.

Clinical governance and Project Cornerstone

The last few weeks have been busy at GenesisCare with Project Cornerstone and we are proud to report that we have delivered on the 3 essential phases of the project, the summary of which is outlined below:

• Phase 1: complete end to end review of our referral to treatment processes, re-design and launch of our patient referral form and disease specific consent forms for radiotherapy, radiotherapy booking checklists, MOSAIQ assessments and design, and launch of a new radiotherapy audit tool to ensure compliance at all times
• Phase 2: complete update and standardisation of all GenesisCare UK policies and protocols, standard operating procedures, work instructions and templates, moving to a single document management system (Sharepoint) as a repository of all company documentation
• Phase 3: re-writing and launching of our employer’s procedures and creation of a competency framework and training program to be implemented within the next 6-12 months

Moving into the phase 4 of Project Cornerstone, which is our long term quality improvement plan, we are working with the global quality and clinical teams to review and refresh our governance framework, risk and incident management policy, training and education strategy, research and clinical trial strategy, as well as our assurance and accountability framework.

Do you have an idea on long term quality improvement? Be part of our transformation journey, James and myself are available to discuss furthur.

GenesisCare is committed to investing early in new, evidence-based modalities and to changing the way people experience cancer treatment and care. Our partnership with The Cromwell Hospital is anchored in this shared vision to ensure fast access to world-class cancer care.

The centre specialises in complex and difficult-to-treat tumours including cancers of the abdomen, central nervous system (brain & spine), head & neck, lung, as well as offering the latest techniques for breast and prostate cancers. Despite some delays due to the COVID-19 pandemic, we’re on track to become Europe’s most advanced radiotherapy centre as the Varian Edge Linac, Gamma Knife Icon and exercise clinic are now live and accepting referrals.

Varian Edge Linac

The Varian Edge is designed to deliver stereotactic brain and spinal surgery, stereotactic ablative radiotherapy (SABR) and volumetric modulated arc therapy (VMAT), making it well suited to manage common tumours such as breast and prostate.

Installation is now complete, and the team are accepting referrals.

We are continuing with commissioning for complex SABR, SRS and H&N and will be in a position to deliver these complex treatments at various time points over the next 4-5 months.

We have a comprehensive SABR credentialing programme for any clinicians who would like to use this modality.

Gamma Knife Icon

Gamma Knife is an alternative to traditional brain surgery and whole brain radiotherapy for the treatment of complex, difficult brain conditions. This included both malignant and benign conditions. Traditionally mainly utilized by neurosurgeons, it is increasingly now the modality of choice for Oncologists due to longer progression free survival in keeping with newer treatments now available to patients such as Immunotherapy and Targeted therapies. Over 1.2 million patients have been treated worldwide and it’s one of the most advanced systems for stereotactic radiosurgery (SRS) delivering with highest possible accuracy for both frame-based and frame less treatments.

Installation is now complete, and the team are accepting referrals and ready to treat patients.

We are also in the process of providing a ‘new user’ course in conjunction with Elekta for Consultants to be credentialed and supervised in GK use.

MRIdian MR Linac

The MRIdian MRLinac allows clinicians to ‘see as they treat’, using live images of the tumour and surrounding tissue to continually adjust the radiation beam for movements and more precise treatment targeting.

Work on this final phase of the project has already begun, and the machine is due to go live in early 2021. This will be the first MRL in London treating patients outside of a clinical trial setting and will be a fully consultant led service.

Credentialing from the Oxford team is currently being offered to Consultants for suitable tumour sites.

More than treating cancer

To improve the care and service we can offer, and at no cost to our patients, a fully equipped gym has been installed at the centre, allowing patients to benefit from prescribed exercise medicine alongside their treatment which is effective in improving treatment tolerance, building muscle mass and reducing cancer related fatigue.

All patients will be offered an HNA (Holistic needs assessment) by our Penny Brohn well-being consultant. Following on from this they will be assessed for complimentary services provided by both Penny Brohn team and the team at the Cromwell- all provided within our on site ‘Penny Brohn’ suite. For patients that require it, they can also be referred to the on site Oncology Psychologist, Specialist dietitian, SALT and CNS services.

Click here to refer to GenesisCare centre for Radiotherapy at Cromwell Hospital visit

If you’d like to discuss any of the above, visit the centre or refer patients to the centre, please contact either Jane or Younan.

This is particularly important if you wish to refer as we will ensure you have PP’s for Cromwell Hospital as all patients are dual registered ensuring access to accessory services such as inpatient beds AHP services etc.

Systemic chemotherapy

NHS England supports the continuation of modified systemic chemotherapy protocols that reduce the risk of immunosuppression and minimise patient exposure to acute hospital environments.

The interim treatment changes will remain in place for the remainder of the financial year 2020/21 to support patient access during the COVID-19 pandemic.

The principles are the following:

1. Aim for treatment that is less immunosuppressive and which mitigates a patient’s likelihood of contracting COVID-19 or becoming seriously ill from COVID-19

2. Choose treatments that can be administered at home or in a setting that reduces the patient’s exposure to COVID-19 (including oral treatments)

3. Aim for treatments that are less resource intensive and make better use of clinical capacity

Some general rules when choosing systemic treatments:

• Give prophylactic daily granulocyte-colony stimulating factor (G-CSF) or a biosimilar PEGylated G-CSF to prevent neutropenic fever and reduce admissions (for example, for patients on chemotherapy regimens with a greater than 10% risk of neutropenic fever)
• After an assessment of the risks and benefits to the patient, consider stopping: later-line palliative treatment to reduce the need for admission adjuvant therapy for low-risk patients, for example those with breast, lung or colorectal cancer, to reduce the need for immune-suppressive therapy

For more detailed information, click here for NHSE guidance

Clinical audit of cytostatic chemotherapy spillage:

We are very proud of our chemotherapy nursing and pharmacy teams whose exemplary clinical practice prevents spillage and assures the cleanliness of our centres and safety of our staff and patients. View the audit for Milton Keynes and Maidstone.

COVID-19 Screening, risk assessment and testing at GenesisCare UK

Consenting cancer patients in clinic or virtually 

We encourage you to routinely discuss the potential implications of your proposed patient treatment(s) in the context of COVID-19 when you consent your patients.The following questions will help you target and document your discussions with patients:

1. What are the risks related to the specific treatment(s) I will be having?
2. What other risks do I face given my personal circumstances (other health problems)? Am I a vulnerable or an extremely vulnerable patient?
3. What is the risk of me catching COVID-19 during treatment and the potential risks as a result of the infection?

In due course, we will be updating our consent forms to include a COVID-19 specific section to prompt you have this discussion with your patients.

Our teams at all 14 GenesisCare centres continue the systematic weekly PCR swab testing for COVID-19 for all employees and doctors working on site.

Our patients are consented orally for the test and they get tested prior to starting chemotherapy, Theranostics and radiotherapy, prior to each chemotherapy and Theranostics cycle and before they attend for minor interventional outpatient procedures.

By doing so, we have kept our patients and staff safe and all our centres open during the pandemic peak and we will continue to do so moving into winter.

Our intense infection prevention and control procedures remain in place.  We have adequate stock of PPE and we are therefore able to flex appointments and treat patients who test positive for COVID-19 but are well, if their clinician feels that the benefits of treatment outweigh the risks.

We remind you that you will receive the following risk assessments on arrival to our centres:

• Questionnaire about any symptoms suggestive of COVID-19
• Temperature check on arrival to our centres
• We will ask you to wash your hands before entry to our centres and at regular intervals whilst working in our centres
• We ask you to keep social distancing rules and wear surgical mask at all times whilst working in our centres

Response to recent publication 

The APPG for radiotherapy has published the following 6-point COVID-19 recovery plan in its recent guidance, click here to view.

We are pleased to say that GenesisCare is at the forefront of this plan through:

• Driving radiotherapy forwards by investing in the newest technology such as Gamma Knife, MR-Linac, SRS and adopting advanced radiotherapy techniques (Breast SIB, VMAT for wide field skin cancerisation, VMAT for palliative cases, SABR for re-treatment)
• Investing in IT and technology solutions by working with global industry leaders and modernising radiotherapy through the adoption of innovative treatment planning solutions
• Replace ageing radiotherapy machines as in the case of GenesisCare at Cromwell Hospital
• Investing in high calibre workforce recruitment training and credentialing (SABR, breast)
• Improving access to radiotherapy through collaboration with other providers including the NHS, Oxford University (Compassionate Access Programme for radiotherapy treating pancreatic cancer patients) and charities (Pancreatic Cancer UK and  Pancreatic Cancer Research Fund)
• Raising the profile of radiotherapy by working with the best clinicians and academics in the UK, linking together global radiotherapy networks and investing in innovation and research

As always, please send us your feedback and improvement suggestions to James or myself.

Kind regards,

James McArthur
General Manager, UK

Penny Kechagioglou
Chief Medical Officer, UK

Over the last few months, oncology care has been transformed in how we, as clinicians see, consent and communicate with patients as well as the treatment protocols we offer. Some of the changes have been implemented very quickly and have had a hugely positive impact in ensuring patient safety and quality of care. For example, the GenesisCare Telehealth and virtual clinic programme, the launch of eMDT and access to remote webinars for training and education.

• Outpatient clinic appointments – Telehealth enabled GenesisCare to offer more remote consultations and set up a number of new outpatient diagnostic clinics such as urology, breast and head and neck, at a time when cancer 2-week waits were put on hold in the NHS.Elective surgery postponed for 3 months – leading to a large backlog of cases and reduced theatre capacity GenesisCare has been open to safely treat patients with chemotherapy or radiotherapy whilst they await surgery.
• Chemotherapies and supporting therapies – were put on hold across the country but cancer patients were given the choice to continue treatment at GenesisCare including continuation of their clinical trial regime.
• Radiotherapy protocols – changed rapidly especially in breast cancer and GenesisCare adopted all RCR-endorsed hypo-fractionated protocols into the revised GenesisCare protocols. We also introduced internal peer review of all hypo-fractionated referrals and have kept you up to date with all clinical changes through our NEW DoctorHub.
• Cancer screening & diagnostic services – were put on hold across the country with reduced capacity; GenesisCare’s response was to open 5 One Stop Clinics across its network to ensure more cancer patients are diagnosed and treated at the right time.
• Holistic therapies – have been compromised due to lack of face to face appointments and GenesisCare has introduced a remote online service for patients who needed support.
• Communication and updates – with clinicians and internal staff has been a regular theme within GenesisCare, through our secure Zoom tool, redesigned website and virtual discussion forums.
• No waiting list for patients – who need to be reviewed urgently, with same day clinic appointment in all our 14 centres.
• Socialising and feedback – YES, that has happened regularly too, amongst small internal groups and with clinicians during the GM evening (virtual) forums and evening Clinical Management Committees (virtual).
• Exercise and wellbeing support – offered remotely to all patients and internal GenesisCare staff, now available to doctors.

• Equal respect and fairness – respect patient choices and keep patients informed
• Working together and reciprocity – support patients and colleagues when taking high risk decisions and share information appropriately
• Flexibility in treatment plans – adapt to changing circumstances
• Open and transparent decision – be inclusive, rational and evidence based
• Minimise the harm of the pandemic – reduce spread, protect patients and staff, disseminate knowledge of what works and what doesn’t

• Virtual consultations and meetings have become safer by introducing password protection to all Zoom calls and providing training for clinicians and staff.
• The eMDT roll out has passed all stages of peer review; this included doctor review by our Clinical Reference Groups (CRGs), Clinical review by our technical staff internally, regulatory and legal reviews to ensure the robustness of data management and Quality review to ensure that robust auditing of the process has been incorporated.
• Electronic referrals have been temporarily suspended via the www2.genesiscare.co.uk referral portal, while we deliver upgrades. Click here to read the latest announcement and access the new radiotherapy referral and patient consent forms.
• It’s important that you continue to include the following points when booking and consenting patients online or on paper:

1. The reason for their treatment and what exactly it entails e.g. breast radiotherapy and SCF or IMC treatment for lymph node positivity – Be specific and clear with your treatment request, including patient position (supine/prone), energy and technique (SIB Boost vs 2-phase Boost, VMAT, electrons)
   
2. The minimum cancer dataset which includes histology, radiology, booking form, MDT outcome and clinic letter should be provided at all times together with the patient referral – Sending complete dataset upfront avoids treatment delays
3. The benefits of the treatment and the risks of not having treatment e g. local and/or distant recurrence and survival – Including risks of catching Covid-19
4. The risk of contracting Covid-19 is slightly higher today and sits at 8% community risk, but potential complications from contracting the virus depends on individual patient risk, based on comorbidities and performance status.
5. Concomitant chemotherapy – State name, dose and treatment timing with RT
6. Statement about pregnancy and pacemaker/ICD device

• There is a national shortage of IV Ranitidine and we have had to make the following changes in the Paclitaxel chemotherapy protocol:
  • For weekly paclitaxel pre-med, to switch IV Ranitidine 50mg 30 minutes pre-chemo to oral Ranitidine 150mg 60 minutes with immediate effect. Consider IV if patient is unable to swallow.
  • For 2 weekly (accelerated) and 3 weekly paclitaxel regimens: Continue with IV Ranitidine. If Ranitidine IV 50mg unavailable, substitute with Ranitidine 150mg PO to be given the day before and again on morning of paclitaxel. If patient has not taken dose on day before, give 300mg po 60 mins prior to paclitaxel.

GenesisCare is the first provider in UK to have successfully rolled out a weekly staff PCR testing program, which has been running now for 6 weeks. The  number of staff testing positive is less than the community prevalence of SARS-CoV-2, all have self-isolated for 7 days, all re-tested negative and remained asymptomatic throughout.

Our testing program also includes our doctors who practice on site and thank you for your support in rolling this out.

Patients have been PCR tested on demand, if they presented with symptoms or if lung changes have been discovered, consistent with Covid-19, on their diagnostic or planning CT.

The next phase of the testing programme, will be done in the context of a research program, sponsored by GenesisCare and will involve regular asymptomatic patient and staff testing using dual Antibody and PCR tests. This is coming soon once final ethical approval is granted.

Some of you may have had the chance to attend the online ASCO 2020 meeting a few  weeks ago. If not, a summary of key clinical messages – Your essential Guide to ASCO 2020 – can be found by here.

As always, any questions or comments don’t hesitate to contact me personally.

Kind regards,

James McArthur
General Manager – UK

Penny Kechagioglou 
Chief Medical Officer – UK

This week is a very special one as we celebrate our entrance into the U.S Market, with the acquisition of 21st Century Integrated Oncology, the 1st in radiotherapy provider in the U.S Market operating across 19 states and in 140 centres. Our global network has just got bigger, with 196 radiotherapy treatment centres across 4 countries (U.S, Spain, UK, Australia) and 443.000 patient treatments per year.

GenesisCare is bringing people and teams together on a global scale, investing in new technology and technological expertise, maximising digital and other forms of innovation in order to make a positive impact on cancer patient outcomes worldwide. We will do this because of our passion for clinical excellence, patient and staff safety and by scaling up our Service of the Future Strategic Model of Care in the U.S, following its successful implementation in the UK, Spain and Australia.

This is a fantastic opportunity for us to replicate our successful UK model in a new Market, including rolling out a Linac replacement programme and investment on MR-Linacs, Digital platforms, e MDT, automation, research and clinical trials. Most importantly, we have the greatest opportunity to connect with world class clinician leaders and academics, share knowledge and expertise and engage each other in high quality research.

The following protocols have been recently endorsed by the Royal College of Radiologists:

Head and neck

• Consider radical radiotherapy if surgery not possible especially oral SCC, paranasal sinus and laryngeal tumours. Hypo-fractionated regimes (20#) and SIB-IMRT to boost nodes ± chemotherapy appropriate
• Consider short RT regimes in palliative cases and oral pembrolizumab as 1stline metastatic instead of chemotherapy
• Full PPE needed when treating those patients
• If patient tests +ve for Covid-19 prior to RT, treatment should be delayed until recovery, if patient develops mild symptoms during RT and tests +ve, treatment should continue and if patient develops severe symptoms during treatment, it should be interrupted until recovery

Lung cancer

• Lung radiotherapy hypofractionation: SABR 54Gy/3# for tumours within 2.5cm from chest wall with consideration of 48Gy/3# if abutting chest wall to minimise toxicity
• SABR for moderately central tumours <2cm from bronchial tree, trachea, major vessels, heart, esophagus, brachial plexus or ultracentral tumours with PTV abutting trachea or main bronchi: 4-5# (ASTRO, 40-50Gy) or 8# UK SABR Consortium (60Gy)
• Central or ultra-central tumours not suitable for SABR, consider hypo# regimes (50-60Gy in 15#)
• SABR for tumour >5cm possible depending on OAR dose should be discussed with our SABR clinical reference group
• Extreme hypofractionation such as 30-34Gy/1# SABR for tumours ≤2cm and >1cm from chest wall and which are outside the no-fly zone, should be discussed with the SABR reference group

Virtual consultations are here to stay and below are few tips around the governance of consenting patients in a virtual setting.

• If you are using the online booking form and consent form, ensure the patient understands the following and that risks and benefits are documented in the consent form ± MOSAIQ electronic health record:

1. The reason for their treatment and what exactly it entails (eg. breast radiotherapy and SCF/IMC treatment for lymph node positivity)
2. The benefits of the treatment and the risks of not having treatment (eg. local and/or distant recurrence and survival)
3. The risks associated with the treatment including risk of contracting Coronavirus (3% community risk) and complications from contracting the virus (individual risk based on comorbidities and performance status).
4. How to take any medication that they are prescribed
5. Acute Oncology information, including GenesisCare 24h nurse line

• If you are using a paper consent form, follow the steps below:

1. Oral consent to treatment explaining the above 1-5 points
2. If patients agree to be emailed the consent form (which includes risks and benefits of treatment as per points 1-3 above), ensure this is documented on their MOSAIQ record together with their email address.
3. Patient will bring the signed consent form to their radiotherapy planning appointment or first SACT treatment and consent will be reconfirmed.
4. If patients don’t agree to have the consent form emailed to them, it can be posted to them and they can bring it to their first appointment

• The presence of a pacemaker and whether dependent or not dependent should be clearly stated on the booking form and clinic letter. The lack of such information upfront may delay the CT planning and treatment start date
• If your patient has gone through the GenesisCare e MDT process, please state in the online or paper booking form along with the date of the MDT. If your patient has been through the NHS MDT, please provide a report or advise how we can retrieve it

• Your patients will soon be approached to have a nasal and oral PCR swab test on a regular basis (see next section for more details). If you have any concerns or you don’t want your patient to be tested, be inform your centre leader

As we move to the post pandemic phase, GenesisCare’s focus is to deliver access to quality rapid testing for all employees, doctors and patients in order to ensure the safety of staff and patients.

The swab PCR weekly testing program which has been rolled out successfully to staff and doctors on site since the 23rd of April, will eventually evolve into a hybrid testing approach utilising:

1. Point of care (POC) test for the Antibody (Ab) to determine who has been exposed to the SARs-CoV-2 virus.
2. The laboratory-based Reverse transcriptase Polymerase Chain Reaction (RT-PCR) test which will identify patients with current infection.

This week, we are piloting asymptomatic patient testing in our Milton Keynes centre using oral and nasal swab PCR, as per the following schedule:

Asymptomatic patients

• On Chemotherapy – testing will be done no longer than 6 days prior to each chemotherapy cycle. Patients will get tested weekly or 3-weekly or depending on the chemotherapy schedule
• Radiotherapy – patients will get tested prior to fraction 1 and on demand thereafter (if they develop symptoms)
• Haematology patients – testing follows the same principles as with chemotherapy patients
• Diagnostic patients will be screened through questionnaires and temperature checks as per our standard procedures

Positive patient result and treating Covid-19 patients at GenesisCare centres

A positive patient result will be communicated to yourselves as referring clinicians as soon as we receive it. According to our partnered lab policy, they will report any positive test results to Public Health England and can provide microbiology advise to you if you so need it. Please discuss this requirement with your centre leader and we will arrange this.

We are supportive of treating well patients with Covid-19 in our centres, if you decide as clinicians to do so. Once a positive patient result is through to us, we will discuss with you on an individual patient basis the operational aspects of treating this patient safely on site. If your patient has already started radiotherapy treatment, we will discuss with you about changing treatment timing for your patient until later on the day. If you wish to delay patient radiotherapy, our expert dosimetrists and physicists will support you around a compensatory dose protocol.

Positive asymptomatic staff results at GenesisCare centres

We test all staff members every week for every centre and the GenesisCare UK research team is leading the testing process, in collaboration with our Director of Operations and Head of People and Culture.

In case of a positive swab test for staff, we advise them a 7-day isolation and we provide a back-up team to cover the service as per our Business Continuity Plan. The staff members get re-tested after their 7-day isolation period and if negative and asymptomatic, they return back to work as normal.

The current rate of positive tests in asymptomatic staff aligns with the prevalence of Covid-19 in the community which is 3% currently.

As UK Leadership team, we are continuing the weekly COBRA calls to ensure that we maintain adequate PPE for staff and patients, adequate cleaning stock, thermometer stock and any defects are replenished immediately. During this call, we share and action with the teams any government or PHE updates and we ensure we share learnings from other centres nationally and internationally.

Antibody (Ab) testing

A validated Antibody testing will soon be introduced to the above protocol for (a)symptomatic staff and patients, to complement the PCR swab test. The protocol for testing is currently subject to ethics approval and will be shared once it is approved.

With Breast and Haematology e-MDTs now up and running at GenesisCare, more patients have access to our clinical expert forums which follow national and international evidence-based protocols. Access to our e MDT will negate the need for these patients to wait longer for treatment until they are discussed in the NHS MDTs.

You will all soon receive an email from your Referrer Engagement Manager (REM) to sign up to the GenesisCare e-MDT in your area. The MDT report will be saved on MOSAIQ patient electronic health record and will be shared with insurers if requested for treatment authorisation purposes.

Our e-MDT platform is safe and easy to use and enables synchronous (virtual forum) and asynchronous decision making. For the Terms of Reference of your local e-MDT, please ask you centre leader or REM.

Don’t forget to visit our new DoctorHub site for the latest updates on clinical protocols, safety and governance processes in centres, business updates and many more.

We would love to hear from you any suggestions for improvement or any specific updates you would like to see more often.

Following the updated BAUS and RCR guidance on how to manage patients during Covid-19, Philip Charlesworth, Surgical Clinical Director and Philip Camilleri, Uro-oncology Clinical Director hosted a webinar to discuss GenesisCare’s response on how this may impact on our private patients wishing to access treatment at during Covid-19. The webinar discusses our intent today, and moving forward as we work through the challenges presented.

Please don’t hesitate to contact either of us directly should you have any further questions.

Kind regards

James McArthur

General Manager – UK

Penny Kechagioglou

Chief Medical Officer – UK

As the country is entering a period of restoration in cancer services, our teams at GenesisCare are here to support you and your patients with fast access to cancer diagnostic pathways for urology and breast cancer, clean and seamless pathways to radiotherapy and chemotherapy, including our MR Linac and SRS service. The safety of staff, doctors and patients is our number one priority at GenesisCare and for that reason we have been running weekly swab testing for staff and doctors onsite, which we will extent to all patients from next week.

Our centres are equipped with appropriate PPE to cover all settings and procedures and you should feel its necessary, face to face clinics and procedures are safe to do on site. We encourage our staff and our doctors to take advantage of the video consultation platform, Telehealth, which we have introduced for consultation and MDTs in order to minimise patient footfall in the centres to protect vulnerable patients and staff. Our research and clinical trial team have put together a proposal for the gradual re-introduction of essential clinical trials, following government guidance.

NEW DoctorHub

Access to our latest innovations, protocols and governance and our business and clinical updates.

James McArthur, UK General Manager chats with Australian – UK Chamber of Commerce.

• Our Horizon portal will shortly be introducedfor Clinical Oncologists which will enable you to easily and securely book patients for treatment by selecting existing evidence-based clinical protocols in a script format
• The DoctorHub,hosted on our website has gone live this week, giving you access to our latest innovations, protocols and governance and our business and clinical updates
• On the 11th of May, we are going live with the first breast cancer eMDT, this is a fantastic step forward to improve our patient quality of care, thanks to all of you, our expert clinical reference groups and the service development teams who have supported the project

NHS England has approved some amendments to the systemic anticancer chemotherapy regimens and delivery of those, whilst we are still in the phase of patient shielding for the next 12 weeks. You can find the guidance in the link below.

It is important that you incorporate Covid-19 into your discussions with patients when you consent them for treatment. The general patient risk for catching Covid-19 in the community (around 3%) will apply to any patient who is coming to our centres, due to travelling involved and other environmental exposures. The risk to individual patients may be higher than that depending on their condition and treatment they are receiving.

SACT interim options during Covid-19

We continue to offer the standard GenesisCare protocols as well as hypofractionated protocols, guided by clinicians. We have incorporated the 26Gy/5# breast protocol ahead of the publication of the Fast Forward trial results and as directed by the RCR.

You can view the Fast Forward trial results paper here

We’re committed to keeping our teams and patients safe during SARS-CoV-2 pandemic and beyond, by delivering systematic rapid access testing for our clinical teams and patients.

The testing program approach started on the 23rd April for asymptomatic staff and doctors who work in our centres. We’ll also test asymptomatic patients from 15th May. In the meantime, we test all patients and staff who present to our centres with symptoms (on-demand testing) using:

• The laboratory-based reverse transcriptase Polymerase Chain Reaction (RT-PCR)
• Nasal and throat swabs are taken in centre for PCR testing or kits can be sent home and we will arrange courier service to the lab at our cost

Asymptomatic patients

• On chemotherapy– testing will be done no longer than 6 days prior to each chemotherapy cycle. Patients will get tested weekly or 3-weekly or depending on the chemotherapy schedule
• Radiotherapy– patients will get tested prior to fraction 1 and midway through patient treatment if the radiotherapy schedule is ≥3 weeks
• Haematology patients– testing follows the same principles as with chemotherapy patients
• Diagnostic patients – will be screened through questionnaires and temperature checks as per our standard procedures

Symptomatic patients

PCR swab testing will take place for patients who are symptomatic. Ideal testing time is around 5 days from symptoms but could be anytime the patients are presented with symptoms. Patients should self-isolate until the PCR swab tests are back and the decision to continue or postpone treatment will be determined in consultation with their referring clinician.

Any patient with positive PCR swab test results will be required to isolate for a minimum of 7 days. During this time the GenesisCare Chief Medical Officer will discuss options with their consultant, including carrying out a virtual MDT to determine best course of treatment.

A further PCR swab test will be carried out after 7 days. Depending on the results, the patient may be treated or is required to continue isolating.

Antibody (Ab) testing

A validated antibody testing will soon be introduced to the above protocol for (a)symptomatic staff and patients, to complement the PCR swab test. The protocol for testing is currently subject to ethics approval and will be shared once it is approved.

All patients who attend for a diagnostic CT scan that includes the thorax and base of lungs and all patients on treatment for breast cancer, lung and mediastinal cancer, oesophago-gastric, liver and pancreatic cancers who receive CBCTs during treatment (or on MRL), will be informed at CT consent or prior to fraction 1 of radiotherapy, that incidental findings suggestive of Covid-19 infection may be found on lungs/lung bases and appropriate steps will be taken as follows.

When reviewing the images radiographers look for characteristic appearances: peripheral or patchy ground glass opacification. If these appearances are seen the radiographer must consult a radiologist while the patient is still on the scanner and essential steps will be taken.

Recognition and escalation of incidental findings suspicious of Covid-19 infection policy

This week we’ve launched further diagnostic services across the network that use world-class clinical protocols and are designed around rapid access pathways that cover every stage, from diagnosis to survivorship. Gold standard feedback has been received from patients – thank you and amazing work to the teams that have been involved in the launch’s of the services.

The diagnostic services are also being supported by a range of marketing activities including digital and social media advertising campaigns, a GP email campaign, a range of new printed and digital content plus other channels to be added soon! See some of the creatives below.

“I think the fact you see patients so quickly is absolutely fantastic – I didn’t even have time to worry about my upcoming appointment as it was booked in so quickly. I’ll definitely be recommending GenesisCare to anyone who may need the service.” Patient, Milton Keynes

One Stop Breast Clinic will enable patients to receive same-day diagnostic testing for breast cancer followed by seamless progression to comprehensive breast cancer treatment if needed.

• Symptoms; lumps, swelling, redness, change in size or shape the breast, nipple changes including inversion, discharge, a rash or crusting, skin puckering or dimpling and persistent pain in the breast or armpit
• Family history
• Further testing outside of routine mammograms

Appointments can be made within 24 hours at Maidstone, Milton Keynes and Cambridge, in may cases results will be received on the same day.

Coming in May to…
Windsor and Oxford

Payment options
A call may be required to the insurer for authorisation or a GP referral letter may need to be issued, depending on the provider. Self-pay options are also available.

• Bilateral mammography from £210
• Ultrasound from £290

UrologyHub offers fast and easy access, to expert urologists and diagnostic services for a wide range of urological health conditions for men and women, including:

• Cancers
• Chronic cystitis
• Enlarged prostate
• Erectile dysfunction
• Kidney and urinary stones
• Lower urinary tract symptoms – such as urinating more often or at night, weak urine flow or urine retention
• Urinary incontinence
• Vasectomy pain or reversal

Appointments can be made within 24 hours at Windsor, Oxford and Cambridge, in many cases results will be received on the same day.

Coming in May to…
Maidstone and Milton Keynes

Payment options
A call may be required to the insurer for authorisation or a GP referral letter may need to be issued, depending on the provider. Self-pay options are also available.

• Consultation from £225
• Ultrasound from £290
• CT scan from £400
• MRI from £450

As always, any questions or comments don’t hesitate to contact me personally.

James McArthur

General Manager – UK

Penny Kechagioglou

Chief Medical Officer – UK

With Easter now past and moving swiftly towards summer, our centres are getting busier with new outpatient clinics being set up in Oxford and new services being built, including our new One Stop Breast and Urology Clinics in Cambridge and Windsor. Our 14 centres are open, COVID-19 clean and with our workforce stronger than ever to provide great care to our patients using all our modalities in diagnostics, chemotherapy and radiotherapy.

As the safety of staff, doctors and patients is our number one priority at GenesisCare, we ensure on a daily basis that adequate PPE is available for all staff. Stocks are reviewed and replenished on a weekly basis when necessary and we have started PCR testing for members of staff in isolation and their close relatives. Our research team is systematically collecting outcome data from those tests and correlating them with symptoms to help us understand the effectiveness of those tests in detecting the virus and the optimal timing of the test.

From next week, we will be in the fortunate position to be able to test our staff and patients with the antibody finger prick test, utilising a robust pathway that we have designed with the support of global infection control experts. The detailed roll out of the testing will be communicated in due course.

Basic Principles

• It is clear from all clinical guidance that has recently been published that diagnostic and treatment work should continue despite COVID-19 when there is capacity to do so, which is exactly what we have managed to do at GenesisCare.
• At GenesisCare, we have maintained all our departments open, including our Linacs, MR-Linac, SRS, PET-CT, MRI, mammography, ultrasound, chemotherapy and One Stop Clinic services and we have introduced Telehealth and eMDT facilities for clinicians to practice safely in a remote environment.
• The timing of onset of radiotherapy can have a profound impact on the chance of cure for triple negative breast cancers, head and neck, lung, cervical and anorectal cancers as well as high risk prostate cancers, whereas patients with oligometastases, hepatobiliary and brain tumours can receive excellent palliation and long term survival with SABR or SRS. We believe that it is our duty to continue to treat our cancer patients with the right treatment modality at the time of presentation

Stereotactic radiotherapy

In recent guidelines brain metastases are not considered a priority cancer treatment during COVID-19. At GenesisCare, we are challenging that approach in that a single fraction (SRS) or hypo-fractionated brain radiotherapy (SRT) can improve quality of life for patients and may delay neurological deterioration from growing tumours. Patients can experience a seamless service at GenesisCare with scanning, simulation and treatment all completed within the same week, avoiding unnecessary delays in treatment.

A recent case using the GenesisCare SRS Service in Oxford
The case of a 46y old man, with known renal cell carcinoma, with a very good response to immunotherapy and performance status 0-1 presented with seizures, with a CT scan and MRI head showing multiple brain metastases. The case was referred to our weekly GenesisCare UK Neuro-Oncology MDT and the outcome was to offer SRS. The patient was treated with SRS to 9 brain metastases and seen 6 weeks after treatment, continuing immunotherapy for his extracranial disease, in low dose steroids, without any focal neurology and performance status 0.

The referral process has been simplified and is supported by our wonderful SRS coordinator, Lisa Meade.
The Neuro-Oncology MDT Team reviews cases weekly via the ContextHealth platform, on Sunday nights, with the SRS Huddle of physicists, radiographers, dosimetrists. The Neuro-Oncology MDT is comprised of Neuroradiologists, Neurosurgeons and Neuro- Oncologists. If the Neuro-Oncology MDT ratifies the decision to treat then this proceeds immediately; if not, the referrer is invited to a Zoom MDT call for a live discussion with the MDT.

Breast cancer

Patients with breast cancer currently face great dilemmas when making decisions about cancer treatment and our teams at GenesisCare have tried to make it simple for clinicians and patients to navigate through those treatment choices.

As such, we have kept our standard breast radiotherapy protocols and techniques, including 15# for advanced node positive disease, VMAT IMC, SIB when boost is required, partial breast irradiation (PBI) and we have also adopted the hypo-fractionated regime (26Gy/5) for selected patients who would benefit.

DIBH is still used for all left sided cancers and selected right sided cancers, including IMC, SIB and PBI treatments.

Prostate cancer

We have listened to our patient feedback and we firmly believe that our patients should be given the choice to start radiotherapy treatment sooner rather than later. Our patient experience forums have told us that the side effects from hormonal treatment can be debilitating and non-comparable to the minor side effects from 5# prostate treatment on the MRL or indeed 20-37# with SpaceOAR(r) Hydrogel insertion.

Our COVID-19 clean centres and our well-trained teams in infection control practices, from our taxi drivers to the receptionists and radiographers, will ensure our patient comfort and treatment safety throughout the treatment course.

SABR

Patients with early stage inoperable lung cancer treated with stereotactic body radiotherapy have a survival benefit compared to patients treated with conventional radiotherapy or no radiotherapy. SABR cause less lymphopenia than traditional dose fractionations, making it a safer treatment modality during COVID-19.

Gomez et al (JCO, 2019) reported their multi-institutional outcomes from Local Consolidative SBRT vs Maintenance Systemic Therapy or Observation for Patients with Oligometastatic Non-Small Cell Lung Cancer. Accrual stopped early due to significant Progression Free Survival benefit of SBRT vs systemic treatment maintenance or no treatment.

Rudra et al (2019, Cancer Medicine) looked at the use of adaptive magnetic image-guided radiation therapy for treatment of inoperable pancreatic cancer. High dose SBRT, only possible on the MR Linac, improves overall survival versus low dose RT (49% 2y OS vs 30% 2y OS) in locally advanced pancreatic cancer.

Palma D et al (2019, The Lancet 393:2051-2058) demonstrated at their randomised phase 2 trial (SABR- COMET) that SABR versus standard of care palliative treatment in patients with oligometastatic cancers offers a significant overall survival advantage of 13 months and a doubled progression-free survival, with no detriment in quality of life.

How to refer a patient for SABR

• Simple SABR
  Refer to any clinical oncology colleague at your local GenesisCare centre with the appropriate credentialing. Your centre manager will be able to provide a list of SABR approved Consultants.
• Complex SABR
  You can refer these cases in the same process if your local centre also delivers Complex SABR. Otherwise you can refer to a centre delivering Complex SABR via the SABR Coordinator,
  Lisa Meade, lisa.meade@genesiscare.co.uk, 07391392605

We have heard about the reduction in theatre space for all types of cancer in the NHS and the private sector during this pandemic and we believe that whenever possible, patients should be offered a suitable alternative such as radiotherapy.

Our centre managers, referrer engagement managers and teams on site are inviting you to discuss your patient treatment priorities, so that we can find together an individualised treatment solution that best suits your patient circumstances.

Following concerns that have been raised by the media regarding security of Zoom, we’re going to be implementing additional security steps to maintain a secure platform. Our IT team are in regular contact with Zoom’s leadership and security teams to further understand these concerns relating to the current encryption mechanisms, we can confirm zoom-to-zoom calls are encrypted, as a further measure we’re going to be implementing a six digit password policy. You should expect to receive a communication next week covering all details on how to get started with the new security process.

Patient Reported Outcome Measures (PROMs) are the gold standard of patient outcome data. They’re provided directly by the patient and avoid the inherent bias’ that comes with clinician reported outcomes.

GenesisCare is excited to announce the launch of our own PROMs programme. This will be done largely

through the launch of a dedicated GenesisCare branded App called PROMiNET.

Over the last few months, our UK Clinical Reference Groups (breast, prostate, SABR and haematology) have reviewed a number of platforms and have agreed a preferred list of patient reported outcome tools. These vary from validated tools such as the EORTC BR45 for breast cancer to a bespoke list of toxicity questions based on CTCAE-PROMs for patients receiving stereotactic radiotherapy on the MRIdian MR-linac, as well as a mixture of standard tool and bespoke questions for haematology patients on chemotherapy and prostate cancer patients receiving radiotherapy treatment. The expectation is that eventually this offering will extend to other disease sites.

Patients will be supported by centre staff and encouraged to download the free App, onto their smartphone or tablet. Once registered, they will be asked to fill out the specific question sets according to their treatment. The App is designed to send out reminder emails with clickable links which will take the patient to their secure question sets.

The introduction of the App commences later this month and will be rolled out across all GenesisCare centres throughout the Spring.

The data will be available to GenesisCare who will then be responsible for the analysis of the data collected. The collection of this data is central to GenesisCare’s value proposition of leading with quality in all that we do.

As the COVID-19 pandemic continues, I wanted to keep you up to date on our treatment status, centre preparedness and business continuity plans.

Treatment continues as usual and we are prepared to treat all patients without delay

GenesisCare remains committed to ensuring that cancer patients can continue to receive the care they need in our centres. All our centres are operating as usual and we are continuing to treat patients without delay. We are working with referring doctors to adjust patient treatment dates and protocols only for those most at risk patients.

GenesisCare continues to be a safe place for patients to receive treatment. We have robust screening processes in place for patients, staff and doctors to protect them and to enable treatment to continue. Our staff are equipped with the necessary PPE and we have sufficient stock to meet our treatment needs

We will undertake a pilot in two of our centres to extend testing to our, staff, patients and our clinicians. The pilot will commence shortly after Easter and once procedures are established we will roll out to all centres. We will keep you informed of when patient testing will begin, the exact process we will follow and your expert involvement in the decision to treat.

We are continually reviewing our approach and pro- actively updating to respond to the science, official guidance and GenesisCare’s global policy.

We are aware that as the spread of coronavirus escalates and pressure builds in the NHS, some patient’s cancer treatment may be delayed or deferred. We encourage you to continue to refer your private patients to GenesisCare and we will arrange appointments, planning and treatment in a timely manner. We are aware several surgical procedures are being rationed or postponed in the NHS to understandably manage capacity. Now more than ever we need to support the NHS to manage scarce resources. Please ensure MDT treatment options include MRLinac as a non-invasive alternative for radical treatment including lung, liver, pancreatic and prostate patients who may be appropriate for MRLinac protocol. Please contact your local Centre Leader or Referrer Engagement Manager to get your patients access to this treatment option.

Patients will naturally feel anxious during this period about whether their treatment will carry on or not and they are asked to make potentially life-saving decisions. We are here to support your patients accessing treatment for breast cancer and prostate cancer with standard

or hypofractionated regimes, in a sterile environment. We encourage you to consider life-prolonging palliative therapies such as SABR for oligometastatic disease
and radiotherapy regimes for unresectable tumours such as pancreatic cancer or to delay surgery as in the case of rectal cancer.

A reminder that our private transport option for those patients that require it also helps limit the risk of infection. Our contracted drivers are following strict screening and hygiene processes in response to our guidance.

Finally, we are continuing to support our patients by offering consultations with Penny Brohn UK, wellbeing consultants remotely who are trained to help cancer patients get through their treatment and the challenges faced during the pandemic.

In order to ensure patients are able to quickly access the diagnostic tests and treatment they need, we are continuing to run One Stop clinics for breast and prostate patients in our Maidstone, Milton Keynes, Oxford and Windsor centres. Cambridge One-Stop clinics will go-live in April and Windsor Breast clinics will begin in May.

Our primary focus continues to be providing a safe and secure environment for our private patients and we are working closely with the private medical insurance companies to ensure streamlined pathways and adequate provision is available in every centre.

We are also working on ways to support NHS patients, as part of the Independent Healthcare Providers Network, of which we are a member. You may have read media coverage yesterday that GenesisCare, together with 2 other private providers, have agreed a deal to treat 20,000 NHS patients, this report is incorrect. Whilst we are ready to support NHS England, no deal has been agreed. NHS England will determine how GenesisCare and other private providers can best support the health system and remain ready to provide cancer care where once this important evaluation has been completed.

Over the Easter bank holiday weekend our centres will remain open to continue to treat patients, as follows:

• Friday 10th April – treating all radiotherapy patients as normal
• Monday 13th April – CAT 1 patients who cannot have a double fraction on Tuesday e.g. dose>2.2Gy /#

The safety of staff, doctors and patients is our number one priority at GenesisCare. We have been proactive in the UK and globally to ensure that sufficient supplies of PPE and infection control products are available to keep our staff, doctors and patients safe. All existing stock of has been fairly distributed to sites.

At GenesisCare UK we have been following Public Health England/World Health Organisation (WHO) advice on the use of PPE for COVID-19. As we learn more about the pathophysiology and presentation of COVID-19, we are adapting our practices pro-actively in advance of PHE and WHO, in order to ensure the maximum protection for our people and patients, whilst keeping our 14 UK sites COVID-free.

Disposable gloves
Must be worn when providing direct patient care and when exposure to blood or other body fluids is likely, including during equipment and environmental decontamination. Non-sterile gloves are sufficient, except when performing aseptic procedures.

Disposable plastic aprons
Must be worn to protect staff uniform or clothes from contamination when providing direct patient care and during environmental and equipment decontamination.

Fluid resistant surgical face masks (FRSM)
Must be worn by all clinical staff during direct patient contact.

Long-sleeved fluid resistant disposable gown
Must be worn when there is a risk of extensive splashing of blood and/or other body fluids or when treating head and neck patients.

Eye protection / face visor
Must be worn when there is a risk of contamination to the eyes from splashing of secretions (including respiratory secretions), blood, body fluids or excretions or when treating head and neck patients. If using reusable safety goggles these must be cleaned with disinfectant wipes between patients.

FFP2 or FFP3 masks
Must be worn together with long sleeved gown, eye protection and gloves in case of contact with patient known to have COVID-19 and for aerosol generated procedures, which for GenesisCare only applies to nasendoscopy procedures in head and neck clinics.

• We have allocated space in our centres for donning and doffing PPE
• See PHE quick guides on donning and doffing full PPE

Click for our full PPE guidance

Full aerosol generating procedure (AGP) and personal protective equipment (PPE) must be worn by all members of the resuscitation/emergency team before entering the room. Sets of AGP PPE is readily available where resuscitation equipment is being locally stored.

No chest compressions or airway procedures should be undertaken without full AGP PPE. If chest compressions or airway procedures are necessary, all staff undertaking these tasks MUST wear eye protection/face visor and long-sleeved fluid resistant disposable gown and an FFP2 or FFP3 respirator mask. Resus council guidance should be followed in all instances.

Non-clinical staff (e.g. receptionists, admin staff etc.) practice social distancing and whenever possible maintaining distance of 2 metres from patients.

Non-clinical staff may choose to wear a FRSM (surgical face mask). If so, masks should be changed every 2 hours or if damaged or contaminated.

Our global taskforce on COVID-19 have been working with global infection control experts and our UK Clinical Reference Group have held talks with several providers of test kits to ensure that we offer the right test for the right cohort of people.

As such and over the coming weeks, we will be rolling out a test programme for all staff and their close carers at home. Subject to final clinical review, we will likely take a hybrid testing approach utilising antibody point of care serology testing and PCR antigen testing via trusted UK laboratories. We will extend this programme to doctors who work on site, our centres and we’ll collect anonymised outcomes to evaluate the effectiveness of this testing programme.

We continue to consult our infection control specialists in the UK to roll out a similar testing programme for our high-risk patients during this pandemic. This testing capability for patients will begin in the next 2 weeks and will provide confidence to patients and their clinicians prior to embarking on essential cancer treatment.

The SABR-COMET trial follow-up was extended beyond 5 years due to the continuous overall survival benefit demonstrated. The summary of study outcomes is as follows:

• SABR-COMET was the first randomised trial demonstrating an impact of any ablative therapy on a primary endpoint of overall survival in patients with oligo-metastases
• The effects of SABR on OS were larger in magnitude than previously reported, with a median OS benefit of 22 months (compared to 13 months in the original analysis), corresponding to an absolute benefit of 24.6% at 5-years
• SABR did not result in a detriment in quality of life, and no new safety signals were apparent
• A finding of a comparatively short median PFS benefit (6 months in this trial) in the setting of a longer median OS benefit generally indicates that post-progression treatment with SABR is influencing the OS benefit
• Patients treated with SABR for oligometastases should undergo imaging surveillancewith salvage SABR used if safe

SABR is indicated in case of 1-5 metastases when the primary tumour is well controlled and re treatment is possible on progression.

At GenesisCare, we are able to offer simple and complex SABR treatment in the following centres.

Our MR Linac service at GenesisCare in Oxford is running a full operational service Monday to Friday, treating patients with radical and palliative intent with SABR.

Following recent publication of emergency COVID-19 radiotherapy guidance by the Royal College of Radiologists, we are best placed to deliver hypofractionated radiotherapy treatments in our MR Linac, with dedicated clinical oncology team on site to support planning adaptation and with remote planning capabilities also available. Our COVID-19 clean service gives patients the extra reassurance when they attend for treatment.

Patients with prostate, lung and pancreatic cancer can be treated radically in only few fractions, with excellent long-term outcomes and avoiding complicated and risky surgery.

We encourage all clinicians to consider SABR treatment during multi-disciplinary team discussions.

Refer for MRIdian
We welcome enquiries and referrals. Any patient referred for MRIdian treatment will be returned to the care of the referrer once treatment has been completed.

To refer to one of our MRIdian specialists
01865 224 864
oxford.enquiries@genesiscare.co.uk

Download a referral form

Pancreatic

• Radical pancreas 15 fraction
• Hypofractionated radical pancreas 5 fraction
• Considerations for treatment of pancreatic cancer

Neuro

• Treatment Guidance

Please ensure any changes to planned chemotherapy treatments including delays, dose reductions and cancellations of full or part treatments are communicated to the pharmacy and chemotherapy teams immediately using department group emails.

Could the changes notification be completed as early as possible to ensure any ordered dose can be stopped to minimise wastage.

Our key focus continues to be ensuring cancer patients receive the care they need in a safe environment. The clinical and non-clinical teams are working tirelessly to ensure our centres remain open and are able to treat patients without delay. Should you wish to talk to myself or Penny about any aspect of your patient’s care, please get in touch.

As the COVID-19 situation continues to change, GenesisCare are adapting our processes and policies to ensure our staff and patients remain safe and that we are able to treat patients without delay. Currently all our centres are operating as usual and we are continuing to treat patients every day. 

Please see below up-to-date communications on services to support patient consultation and treatment.

We appreciate that our surgical and oncology colleagues will face difficult decisions about patient care over the coming days and weeks and it is important that multi-disciplinary meetings continue to take place to navigate through those decisions. GenesisCare is therefore accelerating the roll out of eMDT to ensure all best practice protocols are maintained for patients.

The eMDT platform provides real time, decision making solutions using state-of-the-art video and data collaboration technology which enhances the clinical processes without the technology getting in the way.  Patient care flows seamlessly utilising unique decision-tracking and teleconferencing software which is GDPR compliant and protects the flow of sensitive medical record data whilst maintaining the high standards of confidentiality.

Over the next few days you will receive information and training about how to join our eMDT for discussion of all your private breast, prostate (including Theranostic) and neurosurgical patients.

A short video which explains the eMDT technology platform can be viewed here

Breast

The breast Clinical Reference Group (CRG) feel that it is appropriate to be able to enable clinicians to have the ability to replicate how they may decide to treat patients in the NHS and through their private practice. See links below:

• Detailed explanation from Dr Eliot Sims, Chair Breast Clinical Reference Group
• NEW breast protocol

Prostate

Read here a detailed explanation from Dr Philip Camilleri, Chair Urology Clinical Reference Group, on ways in which we can continue to support prostate patients during this unprecedented time.

This includes:

• 20 and 33 fraction prostate referrals
• 5 fraction SABR for patients throughout the UK on the MRIdian MRLinac in Oxford
• Provision of 5 fraction complex SABR which we anticipate being available in Birmingham, Guildford, Oxford, Cambridge and Nottingham
• SpaceOar insertion under local anaesthetic

SpaceOAR®

As you will be aware, following NHS England’s announcement over the weekend that our private hospital colleagues are pivoting all capacity and resources to support our NHS Trusts as they tackle COVID-19. As a result, all GenesisCare patients referred for a SpaceOAR® insertion scheduled with partner hospitals under general anaesthetic have been cancelled from Monday 30 March 2020.

Therefore, please note that we will be contacting all patients who have been referred to GenesisCare for prostate radiotherapy treatment including SpaceOAR®. We will make them aware that we are notifying you of the options below and that they should contact your secretary in order to discuss how you both wish to proceed.

From next week your patients can access SpaceOAR® under local anaesthetic at:

• GenesisCare Windsor: Consultant Urologists Mr Philip Charlesworth, Mr Marc Laniado and Mr Neil Haldar are all credentialed to provide the service in an outpatient clinic
• GenesisCare Oxford: Consultant Urologists Mr Simon Brewster and Mr Tom Leslie
• GenesisCare Maidstone: Consultant Urologist Mr Hide Yamamoto
• GenesisCare Newmarket: Consultant Urologist Mr Christof Kastner

Alternatively

• Patients have the option to continue with external beam radiotherapy without SpaceOAR® insertion or
• Suitable patients can be referred for 5 fraction prostate radiotherapy on the MRIdian linac at GenesisCare Oxford, where SpaceOAR® is NOT required. Project Primrose is in place to support that process

Starting immediately, and for the next 2 weeks may I request that you only contact Nicki Coxall, Service Development Assistant to discuss your existing and future referrals in relation to SpaceOAR insertions on 07900 484840 or nicola.coxall@genesiscare.co.uk

In the coming weeks we will provide further updates on how we expect to credential more Urologists to extend the local anaesthetic service provision and how this in turn will support all of our sites with additional access for you and your patients.

Thank for your cooperation and understanding.

Chemotherapy - solid cancer

We are adopting best practice and advise the following:

• Consider 3-weekly rather than weekly chemotherapy regimes to reduce patient visits
• Consider GCSF for all high-risk regimes including anthracyclines, taxanes, platinum, haematological regimes and in patients with past history or high risk of neutropenic sepsis
• Consider using genomic testing to guide chemotherapy decisions
• Choose single agent palliative chemotherapies with lower toxicity risk
• In stable patients on oral chemotherapy, prescribe 2 cycles of treatment at any time to minimise clinic and pharmacy time
• Switching intravenous treatments to subcutaneous or oral alternatives where this would be beneficial
• Using shorter treatment regimens, for example 4 cycles of adjuvant treatment instead of 6 cycles
• Decreasing the frequency of immunotherapy regimens, for example moving to 4-weekly or 6-weekly
• Providing repeat prescriptions of oral medicines or other at-home treatments without patients needing to attend the centre
• Deferring treatments that prevent long-term complications such as denosunab
• Offering anti-Her2 treatments for 6 months instead of 12 months
• Using treatment breaks for long-term treatments (possibly for longer than 6 weeks)

Hematological malignancies

• Avoid face-to-face consults and convert to Zoom appointments
• Watch and Wait and if stable/non-progressive, then postpone appointment for 4 months if safe to do so
• Watch and wait and if progressing, at next scheduled appointment, perform local blood test with “bleed and go” with follow up  telephone consult
• CLL Stage B/C needing treatment- review if treatment truly essential and aim to delay
• CLL Non-trial patient / if patient needs immediate treatment now: avoid fludarabine and bendamustine, consider chlorambucil obinutuzumab as alternative for all or Venetoclast ± Obinutuzumab or Ibrutinib
• If on oral BTKi or Venetoclax – perform telephone consult , prescribe medication in advance, “bleed and go” on day with immediate prescription pick up, increase intervals for patients being seen
• Consider postponing Rituximab component of Venetoclax Rituximab during Ritxuximab phase of treatment
• If initiating relapse therapy, oral BTKi would result in less hospital attendance, therefore preferable to VR in this situation
• If commencing Venetoclax, review level of monitoring needed for TLS monitoring
• Consider risk and benefit of IVIG infusions during pandemic period

At GenesisCare, we are committed to providing the best possible treatments for cancer patients, when they need it. We are following current evidence, leveraging our advanced technologies and following robust infection control procedures to ensure our patients continue to receive excellent care during the COVID-19 pandemic.

We appreciate that during this pandemic, clinical protocols need to be adapted and technique capabilities maximised to ensure all cancer patients are treated without delays and their long-term outcomes are not compromised.

The following protocols and techniques are delivered at all our centres and are aligned with the Royal College of Radiologists guidelines.

View protocol by tumour group:

• Gynaecological malignancies
• Breast cancers
• Head and neck cancers
• Lower GI patients
• Urological malignancies
• Sarcomas
• Upper GI malignancies
• Lung cancers
• Neurological malignancies

Or click here to view all protocols

Wherever safe to do so, patients will have treatment, delayed until after symptoms have resolved and isolation period is over.  However, there will be occasions where it is clinically necessary for treatment to continue:

• Radiotherapy and diagnostic patients are scheduled at the end of the day when there are fewer patients and staff in the building
• On arrival patients are provided with a waterproof surgical mask
• Staff contact with patients are kept to a minimum and any staff needing to have contact or to be in close proximity will wear full PPE (gloves, apron, surgical face mask)
• Patients are not held in a waiting room but escorted directly to the department by clinical staff
• Theranostics patients are escorted to the allocated isolation uptake room
• Once treatment is complete patients leave the centre immediately
• Staff continue to wear PPE and clean all hard surfaces with appropriate detergent and disinfectant
• Cleaning contractors made aware and room cleaned at earliest opportunity
• Room remains out of service until full cleaning has occurred

All staff are confident about donning and doffing PPE procedures

Clinicians should continue to discuss with patients the risk and benefits of having treatment at this time.  Informed consent is required and should be clearly noted.

Reference to the complete abstract ‘Estimating risks of COVID infection’ can be accessed here

In line with NICE guidelines vulnerable patients who need case by case discussion regarding treatment are summarised below:

Patients with cancer diagnosis

• People with cancer who are undergoing active chemotherapy and radiotherapy
• People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
• People having immunotherapy or other continuing antibody treatments for cancer
• People having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
• People who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs

Patients with non-cancer diagnosis

• Solid organ transplant recipients
• People with significant respiratory conditions such as cystic fibrosis, severe asthma and COPD
• People with cardiovascular diseases and uncontrolled diabetes
• Women who are pregnant
• People with rare diseases and inborn errors of metabolism

Click here to access the full NICE guidelines

Our dosimetry and physics teams are fully functional and working remotely.  Treatment planning activities will be completed remotely for all doctors with the dosimetrist or physicist from your treatment centre liaising with you to make this possible.  They use remote shadowing software with the capability to screen share and take control over your session. For more simple cases virtual simulations can be used which is used by a large number of our current referrers.

We are receiving a growing number of enquiries from clinicians and from patients directly wishing to fund their own radiotherapy treatment in order to start or continue their treatment as soon as possible.

To streamline the process, we have simplified our tariff by tumour type and modality and reduced the price in an effort to make it as accessible as possible.

We will also offer patients the full supportive suite of holistic services to guide them through their cancer journey including:-

• Private transport to and from treatment appointments to minimise the risk of infection to patients
• Exercise Medicine – bespoke 12-week exercise medicine programme
• Penny Brohn– wellbeing support and counselling, currently being conducted by phone

If you have a patient interested in self-funding their treatment, please contact your Centre Leader who will be able to assist you.

A reminder that in light of recent communications to reduce patient footfall in centres we have requested that all patient consultations are now conducted by video conferencing or telephone. Should you need to be physically present for a patient treatment, consultation or test, please liaise directly with the respective Centre Leader.

Click here for a guide on how to use our video conferencing tool, Zoom

Click here to download the ‘Telehealth for patients at GenesisCare’ guide

Our research team and principal investigators will continue to treat existing cancer patients on life-savings clinical trials at GenesisCare. However, we are pausing further recruitment of patients in order to deploy our nurses and pharmacists to areas of higher clinical need.

NHS England has clearly stated that cancer services need to continue to deliver good care whilst recognising patient vulnerabilities and risk assessing on an individual basis. At GenesisCare, we have taken robust screening and protection measures for our staff and our patients and we will continue to strive to deliver the best possible care.

As the COVID-19 pandemic is changing rapidly, we wanted to keep you up to date with information on our treatment status, centre preparedness and business continuity plans.

Treatment continues as usual and until further notice we are prepared to treat all patients without delay or compromise

GenesisCare remains committed to ensuring that cancer patients can continue to receive the care they need in our centres. Currently all our centres are operating as usual and we are continuing to treat patients without delay.  We will work with referring doctors to adjust patient treatment dates and protocols only for those most at risk patients.

We would like to assure you that GenesisCare is a safe place for patients to receive treatment. At the start of February we implemented a screening process for all patients and visitors and are confident that we have robust measures in place to protect staff and patients. Our approach is being updated pro-actively to respond to the science, official guidance and GenesisCare’s global policy.

We are aware that as the spread of coronavirus escalates and pressure builds in the NHS, some patient’s cancer treatment may be delayed or deferred. We encourage you to continue to refer your private patients to GenesisCare and we will arrange appointments, planning and treatment in a timely manner. A reminder that our private transport option for those patients that require it also helps limit the risk of infection. Our contracted drivers are following strict hygiene processes in response to our guidance.

We are aware several surgical procedures are being rationed or postponed in the NHS to understandably manage capacity. Now more than ever we need to support the NHS to manage scarce resources. Please ensure MDT treatment options include MRLinac as a non-invasive alternative for radical treatment including prostate patients that might be appropriate for all treatment options including prostatectomy or radiotherapy using the 5 fraction MRLinac protocol. Please contact either of us or your local Referrer Engagement Manager to get your patients access to this treatment option.

In order to ensure patients are able to quickly access the diagnostic tests and treatment they need, we are continuing to run One Stop clinics for breast and prostate patients in our Maidstone, Milton Keynes, Oxford and Windsor centres. Cambridge One-Stop clinics will go-live in April and Windsor Breast clinics will begin in May.

We are also working on ways to support NHS patients, both by directly working with Trusts close to our centres and as part of the Independent Healthcare Providers Network, of which we are a member.  Should we start to treat NHS patients, we will keep you informed to ensure you are aware of pathways, procedures and treatment protocols. At the moment we are focused on supporting private patients and managing footfall to ensure we are limiting risk across our network in order that we can continue to treat without interruption.

We believe that all patients should have access to their consultants, prior to and during treatment as part of their care.  However, we request that all patient consultations are now conducted by video conferencing or telephone to reduce footfall in centres.  Should you need to be physically present for a patient treatment, consultation or test, please liaise directly with the respective Centre Leader. The Centre Leaders will support in providing secure video conferencing and ‘how to’ guides for both yourself and patients to ensure the virtual consultation goes as smoothly as possible.

On-treatment reviews conducted with our radiographers will be done via telephone rather than in person. Any patient related concerns will be raised to the patient’s consultant as per our standard process.

We are advising patients to avoid bringing companions to the centre unless it is absolutely necessary to support their care.  In this instance, patients are advised to limit this to one companion only.

We have asked our dosimetry and physics teams to work remotely to reduce staff in our centres as this staff group have remote access.  Treatment planning activities will be completed remotely for all doctors with the dosimetrist or physicist from your treatment centre liaising with you to make this possible.  They use remote shadowing software with the capability to screen share and take control over your session. For more simple cases virtual simulations can be used which is used by a large number of our current referrers.

We have also reviewed the updated guidance which has been issued by the Royal College of Radiologists (RCR) on Friday 13th March 2020.  The RCR guidance is detailed in bold below:-

For patients who are self-isolating, we will discuss the risk / benefit of attending for treatment with our local infection control team, considering the latest government guidance

• GenesisCare is a safe place for patients to receive treatment. Our patients benefit from our smaller departments and our ability to provide remote working for many of our processes.

When capacity is limited, providers consider evidence-based shorter fractionation schedules and deferring radiotherapy for some groups.  

• GenesisCare is committed to maintaining global best practice and will maintain established protocols without the need to move short fractionations unless the referring doctors believes it is clinical appropriate and it is approved by GenesisCare CAT review.

For patients with suspected or confirmed COVID-19 infection, consider cohorting on one machine or in one part of the department. 

• As we typically operate in single linac departments we try not move patients to an alternative linac in a beam matched adjacent site as the RCR guidelines stipulate. We are however, able to take special measures to allow treatment of these patients. This would mainly cover patients where a treatment gap is not possible such as Category 1 patients.  We will continue treatment in as safe a way as possible.  They will be treated at the end of the day, in an empty department with only 2 treatment radiographers present. Staff will wear the advised PPE equipment and clean the treatment area afterwards.

Where gaps in treatment occur, try to compensate as per the RCR guidelines. We recognise that despite this, gaps in treatment may affect outcomes

• We will follow RCR guidance on treatment gaps and offer radiobiological gap calculations to try to ensure that treatment is as close to the initial intent as possible. As commented above, currently we does not expect treatment gaps will occur but will update if operational downtime becomes an issue.

SACT treatments

Our recommendation is that all our clinicians consider adding GCSF support to SACT regimes on iQemo for highest risk of causing neutropenic sepsis, including anthracyclines, taxanes, platinum treatments and hematological regimes.

We will continue to monitor the evolving situation and continue to follow both government and RCR guidelines. Any updates will be clearly communicated with the patients and consultants.

We would like to reassure you that we continue to put our patients care at the centre of everything we do and provide our high standards throughout this situation.

We are aware that you are concerned about coronavirus and need to understand the measures we have taken as a business to prevent the spread of the virus.

Across all our centres, we are doing all we can to safeguard our patients, staff and visitors from the risk of contracting Coronavirus to ensurepatient treatment and care remains unaffected. To date, we haven’t experienced any Covid-19 cases with patient, staff members or visitors and we are continuing to provide clinical services across all centres.

This document is to provide you with some information about how this situation might affect you and your patient care and how you can look after yourself.

Following recent government guidance (issued 12th March 2020), you are advised to stay at home and self-isolate if you have either:

• A new, continuous cough
• A high temperature

You can read the government advice about staying at home.

We are continuing with patient visits and consultations in centre, however, the following guidelines are in place to minimise the risk of any infection.

• You may choose to videoconference rather than have face to face consultations.  Please ask your centre leader about setting up a virtual clinic if patients cannot be served by telephone alone
• No handshaking policy
• Defer large meetings when possible
• Ensure regular handwashing
• Stay at home if you have symptoms and follow government advice
• Disinfect high touch surfaces regularly and between users
• Limit food handling and sharing of food in the workplace

• Avoid crowded places such as public transport, cinemas, restaurants/cafés/pubs, supermarkets at peak time and large gatherings of people, e.g. football matches etc.
• It is fine for them to go outside but try to avoid close (within a metre) contact with other people and for the time being avoid shaking hands
• Patient should stay active and continue with regular exercise in their own home or outdoors or in small groups
• Due to the greater risk of infection due to a reduced immune system, we would advise that they avoid going to public exercise facilities, gyms and swimming pools. Avoid exercising in large groups even outdoors i.e. running groups, track events, team sports
• Patient should minimise the number of home visitors and ask friends/family not to visit you if they have coughs and colds. They should ensure that people they live with understand that they could potentially pass on COVID-I9 even if they feel perfectly well
• If any of your patients develops symptoms and you suspect they have COVID-19 or are diagnosed with COVD-19, it is your duty to report them to PHE after consulting with them that you are going to do so. This is because COVID-19 has been declared communicable disease and a pandemic and this is government advice
• If patients suffer from symptoms of neutropenic sepsis and are suspected or confirmed cases of COVID-19, they should follow standard procedures and ring 999 as per their Acute Oncology 24h advice card

If a patient who is referred for treatment or is undergoing treatment at GenesisCare becomes a suspected or confirmed case of Coronavirus, we will take the following steps to ensure that we fulfil the duty of care for these patients, whilst at the same time protecting our employees, our doctors and the local community from infection spread.

• For patients who have not started treatment yet, we will delay them until the recommended self-isolation period or viral treatment is completed and we have confirmation from the patient GP or hospital clinic that the patient is fit to continue with treatment.
• For patients already undergoing chemotherapy or radionuclide treatments, we will delay the subsequent cycles until the recommended self-isolation period or viral treatment is completed and we have confirmation from the patient GP or hospital clinic that the patient is fit to continue with treatment.
• For patients already undergoing radiotherapy, we have a duty of care and treatment will not be interrupted, unless patients are clinically unwell and/or in-patients. If patients are asymptomatic, we will endeavour to treat them at the end of the day after all other patients have completed treatment. Our employees will be equipped with appropriate protective equipment and the treatment area will be decontaminated immediately after treatment is completed.

We have a team who meet daily to review the Coronavirus situation both globally and here in the UK, making sure we have plans in place to be able to continue to provide clinical care across all centres. We are following the advice and guidance being issued by Public Health England to all healthcare providers and updating our plan in line with any changes or updates.

All staff are being updated weekly with any updated guidance, any changes to process and measures being taken.

Prior to attending any GC centre, all patients and visitors are receiving a telephone call from a member of the GC team who will undertake a screening questionnaire to assess any risk factors of exposure to Coronavirus. If any risk factors known, individuals will be directed to contact the NHS 111 service and follow the advice given.

In the event we are unable to contact an individual prior to attendance at the centre, we ask that all patients and visitors complete a screening questionnaire in the centre on arrival.

You will see posters on display in our centre(s) that explain the symptoms of Coronavirus and request to notify a member of staff if circumstances change during the course of treatment. Handwashing notices are on display to remind all patients and visitors of good handwashing technique.

We have been working with our providers to ensure that we have adequate supply of hand soap and hand sanitiser. At this point in time that we do not anticipate any shortage of supplies to support good hand hygiene provision across our centres. All our staff are trained in Infection Control Prevention and have been reminded of the importance of good principles in infection control and prevention.

Keeping our staff and patients safe is our number one priority at all times. All of our staff have been given instructions about how to look after themselves. Staff will be following government and hospital guidelines to reduce the risks of spreading the virus to patients.

GenesisCare is a global company and as such, we are restricting all international travel until further notice. Here in the UK, we are restricting all travel between centres unless it is essential to support clinical care. We are encouraging teams to use technology where possible to conduct meetings and discussions.

If you think you are risk of COVID -19

Do not enter the centre if:

• you have travelled to an affected area in the last 14 days (please check website below for an up to date list)

OR

• you have been exposed to another person with the virus

AND

• you have a sore throat, a cough or a temperature.

If this applies to you, call 111 and follow the instructions. There is information about affected countries and areas on the government website listed at the bottom of this document.

Please notify a member of staff as soon as possible if any of your circumstances change.

If we become aware that you have been diagnosed or exposed to COVID-19, we may discuss with you about reporting to PHE.

The information for the public about COVID-19 is changing all the time. Please visit the official Government website for up to date information and advice:

• https://www.gov.uk/guidance/coronavirus-covid-19-information-for-the-public
• https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice

There is a government advisory page which can be accessed here on coronavirus information for health professionals on the NHS England website.