UK Clinician information: Coronavirus update

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.

eMDT platform

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.

Protocol guidance and changes

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)

Haematological 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

Radiotherapy protocols during a pandemic

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 here:

Treating COVID-19 patients

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

Risk stratification: chemotherapy and RT

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.

Below a summary of scenarios exploring absolute survival benefit and potential risks in a variety of common chemotherapy

 

NICE guidance

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

Remote planning

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.

Self-pay pricing

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.

Telehealth/ virtual clinics

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

Clinical trials

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.

James McArthur

General Manager, UK

Penny Kechagioglou

Chief Medical Officer, UK 

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