Private Care AUTUMN/WINTER 2020
ROBOTIC REVOLUTION Transforming treatment with urological surgeon Mr Pardeep Kumar Open for business: how we’re reshaping the way we deliver healthcare
AUTUMN/WINTER 2020
BREAST CANCER AT THE ROYAL MARSDEN
THE FACTS
9,000+
patients from the UK and across the world are referred to the Breast Unit every year
WELCOME As the Managing Director of Private Care at The Royal Marsden, I’m pleased to introduce the latest issue of Private Care magazine. Due to the impact of the COVID-19 pandemic, we had to cancel our summer issue as resources were prioritised elsewhere. As we head through the recovery phase at The Royal Marsden, we are focusing on providing the best treatment and care for our patients. In this issue, we look at the changes to the way we provide healthcare as a result of the pandemic. It’s been a difficult time for everyone, including our patients, their family and friends, and our staff. But I’m proud that, with some innovative practices, we are open for business and continuing to deliver treatment and keep patients safe. In central London, we are proceeding with the development of our new diagnostics and treatment facility in Cavendish Square, and I’m delighted that Professor Christopher Nutting has been appointed as the Clinical Director. We’re aiming to deliver this as a ‘clean’ facility, with strict measures in place to mitigate for future incidents of COVID-19. I hope you enjoy this issue. Shams Maladwala Managing Director of Private Care ON THE COVER Mr Pardeep Kumar, Consultant Urological Surgeon
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1st
Breast cancer is the most common cancer in the UK
55,000
women are diagnosed with breast cancer every year in the UK
45
research studies are currently under way in our Breast Unit
70%
of all breast cancers are ER-positive
8 in 10
women diagnosed with breast cancer in England and Wales survive beyond 10 years
FIND OUT MORE
For referrals and enquiries, call 020 7811 8111 or email privatepatients@rmh.nhs.uk
U P DAT E
VIRAL RESEARCH Several studies are looking into the impact of COVID-19 on cancer care
RESPONDING TO THE PANDEMIC THE ROYAL MARSDEN has reacted to the COVID-19 crisis by ensuring that cancer patients could access lifesaving surgery, as well as studying the impact of the virus on cancer treatment.
When the virus overwhelmed intensive care units across the country, many cancer patients found that their operations were cancelled. The Royal Marsden and RM Partners, our local cancer alliance,
established a Cancer Hub to secure available surgical teams and ringfenced theatre capacity so that patients needing urgent surgery could access it during the COVID-19 pandemic. To date, about 1,500 patients have benefited. Meanwhile, researchers at The Royal Marsden have launched several studies at an unprecedented speed to investigate how the virus could affect cancer treatment and care. Professor David Cunningham, Consultant Medical Oncologist and Director of the NIHR Biomedical Research Centre, said: “We are uniquely placed to look at COVID-19 in a cancer setting, tapping into our key clinical and research strengths. “Our teams have been working at pace to establish studies with a focus on immediate impact through to longer-term understanding of this novel virus.”
TALKING POINTS “We have “Advances in “It’s important implemented genomic medicine that we see this several changes to have helped skillset established the way we deliver oncologists unlock across Europe so healthcare, opening their understanding suitable patients up new ways of of breast cancer can undergo working” biology” robotic surgery”
“We’re finding innovative ways to preserve bladder and kidney function by using advanced surgical techniques”
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IN BRIEF
NEW ROLE Professor Christopher Nutting
PhD success
Congratulations to International Patient Relation Officer Nadia Aziz Salman, who has completed a PhD in Cancer Research. Dr Salman, who supports international patients throughout their treatment, said she was proud of her achievement and thanked her colleagues at The Royal Marsden for their support.
Genetics in the mix
Researchers from The Royal Marsden, the Francis Crick Institute and Roche have developed a new method of detecting genetic alterations in tumours. The technique – known as representative sequencing – mixes up tumour tissue so that cells from different areas of the tumour are more evenly distributed to provide a more accurate picture of its genetics. The test builds on DNA sequencing, which we use to find mutations that can be susceptible or resistant to a personalised therapy.
Practice-changing trial
The first-ever randomised trial in advanced anal cancer patients, led by Consultant Medical Oncologist Dr Sheela Rao, has led to a new approach to treatment. The results showed that a combination of chemotherapy drugs carboplatin and paclitaxel was safer and more effective than previously recommended treatments. 4 Private Care magazine
CLINICAL LEAD FOR CAVENDISH SQUARE PROFESSOR CHRISTOPHER NUTTING has been appointed as the Clinical Director of The Royal Marsden Private Care at Cavendish Square. Professor Nutting is a Consultant Clinical Oncologist at The Royal Marsden and Joint Head of the Division of Radiotherapy and Imaging at The Institute of Cancer Research, London. He takes on this new role in addition to his existing responsibilities. Located between Oxford Street and Harley
Street in central London, the new outpatients centre will offer fast and direct access to world-leading diagnostic experts in a reassuring environment. It is due to open in early 2021 and will treat multiple tumour types. In addition to consulting rooms, chemotherapy chairs and a minor procedure suite, the centre will have state-of-the-art imaging facilities, including MRI, ultrasound, computerised tomography (CT), mammography and X-ray.
Professor Nutting said: “This is an exciting new development and will allow us to offer worldclass standards of cancer care in the heart of London’s most respected healthcare district. “Cavendish Square will have the clinical expertise, facilities and technology to provide a leading service. Our multidisciplinary teams will be on hand to offer a personalised approach. Patients can be confident they will be seen in the right place, by the right person, at the right time.”
U P DAT E
CyberKnife number two arrives in Sutton THE ARRIVAL OF a second CyberKnife at The Royal Marsden means that even more patients can now access the latest technology for radiotherapy treatment. Funded by The Royal Marsden Cancer Charity, the machine can deliver radiation to patients with pinpoint accuracy in as little as 15 minutes, meaning less healthy tissue is damaged during treatment and fewer sessions are needed. The Royal Marsden is the only trust in the UK to have the newest
The machine can deliver radiation with pinpoint accuracy in 15 minutes
CyberKnife model, which can treat hard-to-reach tumours – including brain, spinal, lung, neck and prostate cancers – more efficiently than ever before. Having the additional feature of a multileaf collimator (MLC) head means it can deliver radiation more quickly, meaning shorter treatment sessions for patients. The new CyberKnife is located in the radiotherapy department at our Sutton hospital, and is the second such machine in use at The Royal Marsden. The first CyberKnife went online in Chelsea in 2011, making The Royal Marsden one of the first NHS hospitals in the UK to install one. It has since treated nearly 3,000 patients and been the focus of international research.
RESEARCH REVEALED AT VIRTUAL MEETING Experts from The Royal Marsden presented research to thousands of delegates around the world at this year’s virtual ASCO conference. Professor Ros Eeles (below), Consultant in Clinical Oncology and Oncogenetics, presented the results of her BARCODE study, which demonstrated that genetic screening can detect undiagnosed cases of prostate cancer in healthy men at an early stage. The pilot study gave 307 men aged between 55 and 69 scores based on their inherited risk of developing the disease. Eighteen men who were found to be in the top 10 per cent of risk agreed to undergo an MRI scan and biopsy, and seven were then diagnosed with prostate cancer. Meanwhile, Professor Christopher Nutting, Consultant Clinical Oncologist, presented the results of the DARS study, which showed that optimised intensity-modulated radiotherapy can reduce adverse, lifelong side effects in head and neck cancer patients following treatment.
NEW ARRIVAL The CyberKnife suite in Sutton
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ADAPTING TO A NEW REALITY From virtual consultations to delivering medications, we’ve put in place a range of measures to change the way we provide healthcare and ensure the safety of our patients and staff during the COVID-19 pandemic Illustrations: Fernando Volken Togni
AS THE UK’S LEADING specialist cancer centre, The Royal Marsden has played a crucial role throughout the COVID-19 pandemic and continues to provide the highest standards of care for patients. As we adapt to the unprecedented situation, the Trust has implemented
several changes to the way we deliver healthcare in order to adhere to government guidance and ensure that patients still receive the care they need. Here, we highlight the changes to practice we’ve introduced – many of which have opened up new ways of working that are here to stay.
Cancer Hub Patients from hospitals across London can get the surgery they need during the pandemic through the Cancer Hub, a network of surgical teams and operating theatres. This is now being extended to deliver diagnostics, radiotherapy and chemotherapy services.
Pharmacy couriers We now deliver medication from our pharmacy to patients’ homes, meaning patients are able to avoid unnecessary visits to the hospital. This is particularly important for those who are shielding.
Infection control Virtual team meetings Multidisciplinary team meetings can now take place online, bringing together clinical staff from different disciplines to make treatment decisions. This removes the need for staff to travel and means meetings are no longer limited by space and social distancing guidelines.
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Strict infection control is a priority during the pandemic. Anyone in the hospital is now required to wear a face mask and observe social distancing rules. We have also put in place more spacing in communal waiting areas, floor markings and clear signs to remind staff and patients about infection control.
CHANGING PRACTICES
Leading research Researchers have launched several studies to understand and mitigate the impact of COVID-19 on cancer patients. Our research teams have worked rapidly to establish the short-term ramifications on cancer treatment, as well as to develop an understanding of the disease over the long term.
Virtual visits With hospital visits prohibited, patients can keep in touch with loved ones using iPads and Wi-Fi units donated by The Royal Marsden Cancer Charity, and can be virtually accompanied by relatives to their appointments. Patients who don’t speak English can use virtual translation services and support for consultations.
Digital access
Virtual consultations To reduce hospital visits, we have introduced virtual consultations to allow patients to speak with their consultant via telephone or online video calls. Many patients find this more convenient than travelling into London, and prefer to receive test results at home with their family.
Onsite testing Thanks to a donation from the Ralph Lauren Corporate Foundation to The Royal Marsden Cancer Charity, we now have a COVID-19 testing machine in Chelsea. This will allow us to get test results in as little as two hours – so patients can be tested ahead of surgery and staff who are isolating at home can return to work following a negative result.
The Royal Marsden Cancer Charity has donated iPads loaded with tools that enable clinical staff to attend meetings virtually and give them access to the latest research, evidence and guidance. Also, staff can use the Perfect Ward app to conduct audits of clinical areas, including enforcing infection control measures, ensuring medication safety, and evaluating and reporting on patient and staff experience.
For referrals and enquiries, call 020 7811 8111 or email privatepatients@rmh.nhs.uk 
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THE COMPLETE APPROACH The Breast Unit at The Royal Marsden is one of the UK’s largest, offering patients the highest standards of breast cancer diagnosis, treatment and research WITH MORE THAN 9,000 referrals from across the UK and around the world every year, The Royal Marsden’s Breast Unit is one of the largest of its type in the country. Our specialist team provides the latest treatment for all stages of breast cancer and is at the forefront of international research into the development of new treatments, the identification of women at high risk, and breast cancer prevention. “Improving patient access to better and more rapid diagnostics is a priority at The Royal Marsden,” says Miss Fiona MacNeill, Consultant Breast Surgeon. “When breast cancer is diagnosed at an early stage, 8 Private Care magazine
there is a much greater chance of being able to treat the disease successfully, often with less invasive procedures and fewer long-term side effects. “Our Rapid Diagnostic and Assessment Centre is one of the most advanced centres of its kind in the UK, and offers a rapid, one-stop service for all patients with any breast concerns. We deliver appropriate, targeted breast screening so that patients with suspected cancer are able to access the best diagnostic tests and care and get the reassurance they need without delay. Early diagnosis and treatment are absolutely key to saving lives and reducing the burden of treatment.”
Personalising treatment Breast cancer management is being transformed as new approaches to predicting individual patient outcomes are identified and novel targeted treatments are discovered. Professor Stephen Johnston, Consultant Medical Oncologist and Head of the Breast Unit, has led a number of studies to investigate endocrine resistance in breast cancer
BREAST CANCER
that have yielded extremely encouraging results. He says: “In patients with hormone-receptor-positive advanced breast cancer, a new generation of drugs called CDK4/6 inhibitors, used in combination with conventional hormonal therapies, has revolutionised the treatment of the disease. “Results from this research support the delivery of targeted
EXCITING TIMES Dr Imogen Locke, Consultant Clinical Oncologist (above); early diagnosis of breast cancer is vital (right)
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“Tailoring treatment based on the biology of the disease is key” and personalised care in the clinic. Ultimately, the aim is to reduce cancer recurrence and mortality from the disease by delivering the most effective therapy.” With personalised cancer treatment and better therapies being delivered in more sophisticated ways in order to improve patients’ quality of life, Dr Imogen Locke, Consultant Clinical Oncologist, believes that this is an exciting time to be working in the field of breast cancer. “Historically, for example, all breast cancer patients would undergo broadly similar radiotherapy treatments, whether their prognosis was good or poor,” she says. “However, advances in genomic medicine have helped oncologists unlock 10 Private Care magazine
their understanding of breast cancer biology so that treatment can now be ‘risk-adapted’ to each individual, and so patients aren’t under- or overtreated. Techniques such as intensitymodulated radiotherapy can target a tumour more precisely without compromising healthy tissue.” The role of surgery The Royal Marsden is also at the vanguard of new approaches to breast cancer from a surgical perspective. With breakthroughs in new techniques and sophisticated collaborations between oncological and plastic surgeons, every patient who needs surgery is offered the most advanced options – not only to remove their cancer,
RESEARCH FOCUS Professor Mitch Dowsett (above left) led the development of a new approach to identifying breast cancer patients who need urgent treatment
but also to reconstruct their body and ensure the best possible aesthetic outcome. “Some of the greatest advancements in the past five years include how the role and extent of surgery for breast cancer patients is being changed for the better,” says Miss MacNeill, who specialises in oncoplastic and breast reconstruction surgery. “We are altering the sequence of surgery, radiotherapy and drugs to deliver more targeted, individualised care that will help to reduce the amount of treatment and levels of toxicity a patient receives. Targeting and tailoring treatment based on the biology of the disease is key to improving survival rates.”
BREAST CANCER
from the comprehensive service provided by our national and international specialists.”
ADVANCED OPTIONS Miss Fiona MacNeill, Consultant Breast Surgeon (top); Professor Stephen Johnston, Consultant Medical Oncologist and Head of the Breast Unit (above)
Pandemic response As a result of the COVID-19 pandemic, the Breast Unit – and the rest of The Royal Marsden – has implemented new ways of working, including the introduction of virtual consultations (read more on page 6). “We have accelerated a number of changes to benefit and protect our patients, including the launch of telephone clinics and virtual consultations, which are transforming patient access to specialist care,” says Professor Johnston. “We have a talented multidisciplinary team. By investing in our digital resources to provide more support virtually, more patients in the UK and from around the world will be able to benefit
Pioneering research Researchers at The Royal Marsden have also been responding to the pandemic by developing an innovative approach to selecting breast cancer patients who need urgent treatment. Using data from multiple international trials, a new algorithm can identify postmenopausal patients with primary ER-positive, HER2negative breast cancer – a type that accounts for 70 per cent of all cases – who have less endocrine-sensitive tumours and who should be prioritised for early surgery or neoadjuvant chemotherapy. The development of the algorithm was led in the UK by Professor Mitch Dowsett at The Royal Marsden in collaboration with the Breast Cancer Now Research Centre at The Institute of Cancer Research, London. Professor Dowsett says: “By accessing unpublished results from clinical trials involving thousands of patients and working with colleagues here and abroad, we have developed a new way of directing patients’ treatment in this global crisis. “The speed and openness of this collaboration to help our patients as rapidly as possible has been unparalleled in my 30 years of experience.”
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MACHINE LEARNING Professor Vinidh Paleri
ROBOTIC SURGERY
HAVE ROBOT, WILL TRAVEL Our expert surgeons are ensuring that robotic surgery benefits patients far and wide by training colleagues and establishing programmes at hospitals across the UK and Europe
THE ROYAL MARSDEN revolutionised the way we treat cancer patients in 2007 when – thanks to funding from The Royal Marsden Cancer Charity – we became the first hospital in England to introduce the da Vinci robotic surgical systems. Since then, our surgeons have performed more than 3,000 robotically assisted operations and have established surgical and nursing fellowship programmes, both also funded by the Charity. A core aim of the service is to benefit patients not just in London, but also elsewhere in the country and further afield. To this end, expert surgical teams from The Royal Marsden have helped to set up robotic services in hospitals across the UK and Europe. Professor Vinidh Paleri, Consultant Head and Neck Surgeon, has provided hands-on training to 33 surgeons at 16 NHS trusts around the UK and at the University Hospital of North Norway in Tromsø, home of the northernmost surgical robot in the world. He has also helped these trusts to develop their own head and neck robotic services, devising strategies based on local resource constraints, management protocols and securing the necessary regulatory approvals. He also directly supervises and advises surgeons early in their learning, before recommending that a permanent service can be rolled out to patients.
“It’s important that we see this skillset established across the UK and Europe so suitable patients can undergo robotic surgery in a safe and regulated environment,” says Professor Paleri. “It means patients benefit from the highest standards across every aspect of care, assessed as part of a tight governance framework that every NHS hospital works to. With recent trials showing the benefit of robotic surgery, The Royal Marsden has indirectly helped thousands of patients nationwide.” Our da Vinci robots provide a magnified 3D view inside the patient and allow surgeons to remove cancers with greater precision and control than ever before. This means surgeons can also operate on tumours that are hard to reach or were previously inoperable. “Robotic procedures have made an incredible difference to the patient’s quality of life after surgery,” says Professor Paleri. “It’s exciting to be on the front line of delivering this with my colleagues around the world, and seeing the benefits for patients is incredibly rewarding.”
PROFESSOR VINIDH PALERI Consultant Head and Neck Surgeon Professor Paleri is a leading head and neck surgeon, and one of the few in the UK with expertise in robotic surgery for head and neck cancers. He has been a Consultant Head and Neck Surgeon for 15 years and joined The Royal Marsden in 2017, where he has been instrumental in establishing a robotic head and neck programme. Alongside his extensive clinical experience, Professor Paleri is a chief investigator on several multicentre trials, and has published extensively about head and neck cancer. He edited the fourth and fifth UK National Multidisciplinary Guidelines for Head and Neck Cancer, and advises or serves on the panels of numerous national and international associations.
“Recent trials have shown the benefit of robotic surgery”
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MR PARDEEP KUMAR Consultant Urological Surgeon MR PARDEEP KUMAR is a specialist in urinary tract cancers and reconstruction at The Royal Marsden. He trained in London and gained fellowship experience in the USA and Egypt. As a Consultant Urological Surgeon, Mr Kumar uses the latest techniques to optimise cancer control and maintain a patient’s quality of life, including robotic surgery to treat prostate and bladder cancers. In addition, he works with sarcoma, colorectal and gynaecological surgeons to treat advanced pelvic malignancies. He also has a special interest in diagnostic urology; in particular, MRI-guided prostate biopsy and narrow-band imaging of the bladder.
The Royal Marsden has the most comprehensive robotic surgery programme for cancer in the UK, with a unique group of expert surgeons working across head and neck, urological, gynaecological, gastrointestinal and colorectal cancers. Mr Kumar has a special focus on training and mentoring. He holds a PhD in applied physiology, has published more than 50 peerreviewed papers, and has supervised PhD and MD students in his consultant role. In 2016, he helped to establish the first worldwide multispeciality robotic and pelvic exenteration fellowship at The Royal Marsden to train more consultants in leadingedge robotic techniques.
CAREER HIGHLIGHTS 1999 Graduates from Manchester Medical School 2006 Gains PhD in Applied Physiology at the Institute of Urology, London 2011 Completes Higher Surgical Training in the South Thames region 2011 Undertakes fellowship training at the Institute of Urology, Mansoura, Egypt 14  Private Care magazine
Q&A 2012 Undertakes fellowship training at the University of Southern California, USA 2012 Appointed Consultant Urologic Surgeon at The Royal Marsden 2012 Becomes Lead Robotic Surgeon at The Royal Marsden 2016 Establishes first multispeciality robotic and pelvic exenteration fellowship
Q What services do you provide at The Royal Marsden? A The Urology Unit is a world leader in the diagnosis and treatment of prostate, kidney, bladder and testicular cancers. We provide a number of state-of-the-art diagnostic services, including the investigation of blood in the urine and advanced prostate cancer diagnosis using
C O N S U LTA N T F O C U S
“At The Royal Marsden, we offer all options for bladder reconstruction, and our results are among the best in the world” invasive keyhole surgery. I have led the robotic surgical programme since 2012. Over the years, it has grown from performing surgery on just one tumour type – prostate – to an all-encompassing robotic programme offering training and mentoring across a variety of tumour types.
MRI-guided prostate biopsy. We offer a range of treatments such as image-guided radiotherapy, stereotactic radiotherapy – which is delivered on the CyberKnife – and the latest surgical techniques. Q How does robotic surgery fit into this? A Robotic surgery has revolutionised the way we treat cancer patients, allowing complex procedures to be performed using minimally
Q What areas of research are you involved in? A My main areas of research include investigating invasive bladder cancer survival and the outcomes of urinary tract reconstruction, as well as identifying how we can best preserve organ function after surgery and improve quality of life for patients. At The Royal Marsden, we offer all options for bladder reconstruction, and our results are among the best in the world. Another research focus I have is on MRI-guided prostate biopsies. We introduced one of the first image-guided MRI systems in Europe that could guide a biopsy needle by superimposing the MRI scan onto the ultrasound in order to improve results and identify more significant prostate cancers at an early stage. Q What does the future look like for urological cancer patients? A From a surgical perspective, we’re increasing cure rates of bladder and prostate cancers
and working to identify minimally invasive treatments and bladder-preserving strategies to improve patient outcomes and quality of life. For example, there will be more alternatives to the complete removal of the bladder. We’re finding innovative ways to preserve bladder and kidney function by using advanced surgical techniques to remove only part of the organ, alongside combined treatment options such as chemotherapy and radiotherapy. Q During your career, what have been the biggest changes in treatment for these patients? A Personalised medicine has transformed patient treatment and care over the past 15 years. We can now create a care plan that is tailored to each patient, rather than having a one-sizefits-all approach. There have been huge improvements in treating urology patients with metastatic disease, helping them to gain long-term control of their cancer and improving survival rates. And the development of innovative techniques to reduce the invasiveness of treatment and surgery means we’re able to preserve more normal function in organs and nerves, so our patients experience less pain, recover more quickly and leave hospital sooner – and have a better quality of life.
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As Europe’s largest cancer centre, The Royal Marsden has the expertise, facilities and technology to provide the highest standards of personalised care, and we treat more private patients than any other UK centre. By choosing The Royal Marsden, you are ensuring the best possible treatment and care, at the moment a patient needs it most. Because where a patient goes first really matters.
Life demands excellence
To refer a private patient, contact our Central Referral and Information Line on +44 (0)20 7811 8111 or email privatepatients@rmh.nhs.uk royalmarsden.nhs.uk/private