Wednesday, 12 November 2014

Day Three - NCRI Cancer Conference

In order not to end up with too many or too lengthy posts on the conference I'm going to limit myself to writing about just one of Tuesday's sessions in what was actually a very busy day, and to mention in passing the ICPV poster.

The poster (number B146) was about the VOICE course, which has now run twice in conjunction with Barts Cancer Institute, Queen Mary University of London.  This year's course was clearly as successful as the one I attended last year.  The abstract can be found on the conference web site at:

More about the VOICE course can be found on the ICPV web site:

My highlight session for Tuesday was 'Optimising care for those living with and beyond cancer - where does primary care fit?'  In my personal view, this is an increasingly important topic both for cancer services as a whole and at the individual patient level.  The session was up against some strong competition in its time-slot but gathered an excellent group of speakers and participants.

Firstly Fiona Walter presented a review of studies and a survey of GP attitudes.  She highlighted the point that one in four people living with and beyond cancer face poor health post-treatment.

After that Jon Emery from Melbourne presented a review of primary and secondary care in follow up. There was no difference in wellbeing, recurrence, survival or satisfaction between primary care and hospital follow up methods. However, the shared care model did show some increase in satisfaction.

He then went on to discuss the ProCare Trial; a multi-centre phase II RCT of shared care for prostate cancer patients.  What struck me as particularly positive about this trial was that follow up visits were planned with care in advance to result in a structured consultation.  When it was experienced, the shared care model was the most popular.

The third presentation of the session was a powerful double act by Alistair Thompson, now at MD Anderson Cancer Centre, Houston (and formerly at Dundee) and Maggie Wilcox of ICPV.  Their presentation looked at front line perspectives on care for women treated for breast cancer.  It was enhanced by Alistair's perspectives of both UK and US healthcare systems and it focussed on the surgical pathway and follow up, consequences of endocrine therapy and upper limb issues.

Alistair spoke about the use of pain relief to support early discharge from hospital, while Maggie pointed out the need for individualised decisions regarding length of stay, especially for those who live alone or conversely in busy households with young children.

Endocrine therapy issues referred to options for extended therapy and the fact that effective symptom management is an unsolved problem and that there is less than a 50% adherence to tamoxifen for five years.  It was also pointed out that many women switching from tamoxifen to an aromatase inhibitor are not informed that the AI remains in the system for a far shorter time than does tamoxifen, so consistency of timing is more important.  This does chime with my own experience when I switched.  I did my research and so knew that the half-life of exemestane is much shorter than that of tamoxifen, but no-one in my medical team has ever mentioned this.

Minimising upper limb complications was discussed as it is an important issue for may people and in addition to Maggie's input there was an extremely insightful intervention from Margaret Grayson, who pointed out that travelling by air with the frame she needs for her sleeve for lymphoedema  can be somewhat challenging.

There was then time for a good number of questions from the floor before the session would up and we dispersed with a good deal of food for thought.

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