RM M A G A Z I N E SUMMER 2019
PERSONAL EFFECTS Helping patients deal with the side effects of cancer treatment
Our pioneering approach to gynaecological cancers How gene tests benefit our young patients
At The Royal Marsden, we deal with cancer every day, so we understand how valuable life is. And when people entrust their lives to us, they have the right to demand the very best. That’s why the pursuit of excellence lies at the heart of everything we do.
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EXECUTIVE NOTES
CONTENTS 4 Bulletin What’s happening around The Royal Marsden 12 On your side How we help patients cope with the side effects of treatment 17 It happened to me How breast cancer challenged Professor Deborah Bowman’s views on medical ethics 18 A day in the life We spend time with Senior Radiotherapy Physicist Honorata Chajecka-Szczygielska 20 The pursuit of excellence A focus on the work of our Gynaecology Unit 24 In our DNA Ensuring our young patients benefit from genetic testing 26 Fundraising News from The Royal Marsden Cancer Charity 28 Foundation news Updates from our Foundation Trust and Governors 30 Puzzles and prizes Test your wits and win a prize with our crossword
WELCOME to the summer 2019 edition of RM, the magazine for our staff, patients, carers and Foundation Trust members. At The Royal Marsden, we ensure we not only treat a patient’s cancer, but also the side effects of their treatment. On page 12, we take a look at how our clinical teams take care of patients who are dealing with speech, skin or dietary problems as a result of their treatment, and speak to some of those patients about their cancer journeys. We also highlight the pioneering work The Royal Marsden is doing in providing genetic sequencing for the diagnosis and treatment of paediatric cancers (page 24). The NHS Long Term Plan has set a goal of giving every child with cancer access to genetic testing, and staff at The Royal Marsden are working with our partners to make this a reality. And our regular Day in the Life feature (page 18) focuses on one of the unsung areas of our world-leading radiotherapy work: the physics team. Medical physicists play a vital role in planning radiotherapy treatments – 50,000 of which we deliver every year – and are critical to the research projects we run in our Radiotherapy Department. I hope you enjoy this issue.
31 Stay in touch Your comments on social media, plus hospital contacts
Cally Palmer CBE, Chief Executive, The Royal Marsden
ON THE COVER Grainne Brady, Clinical Lead for Speech and Language Therapy
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B U L L E T I N W H AT ’ S H A P P E N I N G A R O U N D T H E R O YA L M A R S D E N
Test the waters WATER HAS SIMILAR properties to some human tissue in the way that it scatters and absorbs radiation. This is why radiotherapy physicists use large tanks filled with water when testing linear accelerators, or linacs – complex machines used to deliver radiotherapy at The Royal Marsden. During quality assurance checks and machine commissioning, radiation is passed through the tank to allow the measurement of its effects. As well as being cheap and readily available, water allows the physicist to move a detector around in the tank to measure the amount of radiation in different places. The green lasers are used to precisely set up the water tank, as well as to align the patient on the linac bed prior to radiotherapy. Find out more about the work of our radiotherapy physicists on page 18.
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NEW TRIAL Consultant Haematologist Dr Emma Nicholson
? DID YOU KNOW? Membership of The Royal Marsden is free and open to all, and gives you a say in how our services are run. How involved you are is entirely up to you, and you could help improve services for patients, their families and carers. Find out more at royalmarsden. nhs.uk/ membership.
Patients begin CAR-T cell treatment trial THE ROYAL MARSDEN has recently been approved by NHS England to deliver a new type of immunotherapy for patients with relapsed or refractory diffuse large B-cell lymphoma. Chimeric antigen receptor T cell (CAR-T cell) therapy uses the patient’s own immune system to fight cancer. It involves collecting the patient’s own T cells, genetically modifying them to express a novel antigen receptor to enhance their ability to target and kill cancer cells, and then reinfusing them into the patient. A Phase III trial at The Royal Marsden, ZUMA-7, is comparing CAR-T cell therapy with the current standard of care in patients with diffuse large B-cell lymphoma that has relapsed or has been resistant to treatment.
Thomas Romain, 27, was randomised to the CAR-T cell arm of the ZUMA-7 trial after his non-Hodgkin lymphoma became resistant to standard first-line chemotherapy. He said: “When I found out that I was eligible for this trial and it may give me the chance to go into remission, I had to give it a go.” Dr Emma Nicholson, Consultant Haematologist at The Royal Marsden, said: “CAR-T cell therapy has shown effectiveness in patients with multiply relapsed diffuse large B-cell lymphoma who are resistant to standard chemotherapy and have limited curative options.” The Royal Marsden will expand the use of T cell therapies for patients with solid tumours later this year, with trials in melanoma due to open soon. RM magazine 5
BACK HOME Patients with blood cancers typically spend long periods of time in hospital receiving chemotherapy – but some are now able to receive their treatment at home, thanks to 20 new ‘chemo backpacks’. Funded by the Worshipful Company of Cordwainers’ donation to The Royal Marsden Cancer Charity, the Chemotherapy Ambulatory Delivery Device (CADD) pumps can be taken home in specially designed rucksacks. Blood cancer patient Philippa Constantine (above), 40, who was diagnosed with acute myeloid leukaemia, said: “I was in hospital almost every day for six months, then I was able to have my third and fourth treatment cycles using my own rucksack. “The tubes connecting the treatment to my arm were all under my clothes, so I blended in. I was able to meet friends for dinner, go out for coffee, watch fireworks on Bonfire Night and go shopping. It really helped take my mind off what I was going through.” 6 RM magazine
PUT TO THE TEST Alex Burchell helps prepare the MR Linac for treating children
Further MR Linac progress EIGHT MONTHS AFTER treating the first UK patient with the pioneering MR Linac, The Royal Marsden and The Institute of Cancer Research have tested the machine’s imaging technology with paediatric patient Alex Burchell, 13, in preparation for treating children with cancer in the future. Alex, who is undergoing radiotherapy for a glioma brain tumour, volunteered to be scanned so the equipment could be tested and calibrated for younger patients. His dad Steve said: “We were really pleased to be asked to help the clinical teams prepare for treating children on the MR Linac.
The Royal Marsden has done so much for us during Alex’s treatment and he absolutely loved being scanned. It’s great to think that he is helping patients like him to be treated on this machine in the future.” The MR Linac is the first machine in the world to combine two technologies – a magnetic resonance scanner and a linear accelerator – allowing radiotherapy to be adjusted in real time and delivered more accurately and effectively than ever before.
“Alex is helping future patients like him to be treated”
Prostate cancer patient Barry Dolling, 65, was the first UK patient to be treated on an MR Linac last year. Since then, 12 patients have been treated using the pioneering technology, with a new trial for rectal cancer patients opening recently. Professor Robert Huddart, the trial’s Principal Investigator, said: “Rectal cancer responds to high-dose radiation, but is challenging to focus treatment on. The MR Linac will allow us to adapt the treatment each day to better target the rectum and safely deliver higher doses of radiation. “We hope this will improve the effectiveness of treatment with fewer side effects.”
BULLETIN
Our first nurse fellow in robotics starts THE INAUGURAL TRAINEE has started The Royal Marsden’s Robotic Nursing Fellowship – the first hospital-based fellowship of its kind in the UK. Marie Taniacao, Theatre Scrub Nurse and Surgical First Assistant, is currently performing as a Trainee Surgical Care Practitioner. She is studying towards an MSc in Surgical Care Practice, specialising in gynaecological, upper gastrointestinal and colorectal surgery. This qualification will provide her with a deep knowledge and understanding of robotic surgery – comparable to that of a junior doctor – so she
can better support and assist the surgeon. Marie said: “I’m so excited to be the first fellow in robotic nursing, and extremely grateful for this opportunity. “It will place me and all future trainees in a better position to ensure patient safety and a high standard of care during robotic surgery. We will be more capable of attending to patients while the surgeon is operating on the da Vinci Xi.” Funded by The Royal Marsden Cancer Charity, the fellowship will help to further establish The Royal Marsden as a globally recognised centre of robotic excellence.
Keep on moving
? DID YOU KNOW? You can support our work by shopping online with Amazon Smile. Just select The Royal Marsden Cancer Charity from the listed charities at smile.amazon. co.uk, then shop as normal. You’ll help us to raise money without spending a penny extra.
Clinical staff are being encouraged to educate patients on the benefits of exercising during treatment. Katharine Malhotra (below), a Darzi Fellow funded by The Royal Marsden Cancer Charity and Health Education England, is designing a strategy for physical activity. She has surveyed the views of clinical staff on physical activity, and will be holding a stakeholder event with patients and staff. The aim is to improve support by better integrating physical activity into patients’ treatment. Katharine said: “We know physical activity can reduce the side effects of cancer treatment, boost mental wellbeing and potentially lower the risk of some cancers recurring. “We all have a role to play in encouraging patients to be more physically active – this may involve structured exercise in a gym, for example, or getting out and walking or gardening.”
BACK TO SCHOOL Marie Taniacao is The Royal Marsden’s first Robotic Nurse Fellow
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INNOVATION DEN TO IMPROVE SERVICES Colleagues at The Royal Marsden can now enter the Innovation Den, a Royal Marsden Cancer Charity-funded initiative that aims to unlock the creativity of our staff in order to improve our services. Our staff often have great ideas about how to make improvements, but they may not know how to suggest them or have the resources available to implement them. Now, all Royal Marsden staff can pitch to a panel of judges and apply for funding of between £5,000 and £60,000 for projects that improve patient safety or experience. The first Den sat earlier this year and selected four projects to receive funding, including short tutorial films to provide guidance for readers of The Royal Marsden Manual of Clinical Nursing Procedures. Eamonn Sullivan, Chief Nurse, chaired the session and said there had been stiff competition: “We had more than 26 applications, of which we shortlisted nine to pitch to us in the Den. “The successful pitches were all fantastic ideas with incredible potential and benefit for our patients. It is thanks to the Charity and its supporters that we are able to provide the opportunity to take these ideas forward.”
Virtual reality for patients A NEW STUDY involving the use of virtual reality (VR) headsets has started at The Royal Marsden. The SafeSpace study, supported by Macmillan, will investigate whether VR technology could help improve cancer patients’ wellbeing and reduce their stress and anxiety when undergoing treatment. Lead researchers Professor Theresa Wiseman, Lisa Murray and Geraldine O’Gara will provide ‘compassionate mind training’ (CMT) to 20 participants through VR headsets, which they hope will help patients to relax and allow them to learn coping tactics.
Professor Wiseman, Lead for Health Services Research, whose role is funded by The Royal Marsden Cancer Charity, said: “We are the only trust in the UK to deliver CMT through VR headsets. “With the cost of VR technology falling, this could be a cost-effective solution used across the country.”
VR technology could help to reduce stress and anxiety during treatment
LOOKING UP A patient tries the virtual reality headset
Neurosurgeon’s fascinating talk This year’s William Marsden Lecture took place in March, with neurosurgeon and author Dr Henry Marsh presenting ‘What I learned from 40 years of neurosurgery’. In a 50-minute speech, he explained why he became a neurosurgeon: “Excitement and drama, love of patient care, fascination of the brain, using my hands… and an inspiring teacher.”
Want to know more? See a video of the lecture at royalmarsden.nhs.uk/william-marsden-lecture-dr-henry-marsh
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BULLETIN
STERLING SERVICE Library Supervisor Pamela Drake
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FAST FACTS Rare cancers
1 in 5
people diagnosed with cancer have a rare cancer
Recognition for long-serving staff PAMELA DRAKE, LIBRARY Supervisor in the Medical Records Department, and more than 200 of her Royal Marsden colleagues have been celebrated for their extraordinary longevity at this year’s long service awards. Held in February and March, these awards recognised staff who have worked at the Trust for 10, 20, 30 or, in Pamela’s case, 40 years. Attendees received their awards and enjoyed afternoon tea with Chief Executive Cally Palmer and Non-Executive Director Mark Aedy in Sutton, and Chairman Charles Alexander in Chelsea. Pamela joined The Royal Marsden in August 1977 as a Medical Records Clerk and, 42 years later, is now due to retire. “I thought I’d stay for a few years, but The Royal Marsden is one of
those places where you want to stay,” she said. “The people you work with make you want to stay, and the feeling is exactly the same – everyone loves the place. “When I started, there were no computers, the secretaries typed up the case notes and appointments were all written by hand. We would go to the appointment desk, take out one of the cards, copy them using carbon paper and go and get the records. “We’ve got more and more records as the years have gone on, as treatments have got better and patients are living longer. Some of our records go back 20 or 30 years with patients still coming in for follow-ups, which is lovely. “I will miss it a lot when I retire – the place and the people. It’s been a huge part of my life.”
80+
cancers are classed as ‘rare’
Fewer than 6 in 100,000 people diagnosed annually with a specific form of cancer means it is classed as ‘rare’
1 in 3 diagnosed rare cancers are classed as ‘very rare’
14%
of rare cancers are of the digestive tract RM magazine 9
IN BRIEF
can have an impact on cognitive processes, including radiotherapy, steroids and some medications. Q Why are you looking into this? A Despite the widespread nature of CRCI, in the UK there is little to no standard of care in a hospital setting. We think it’s really important to not only establish a service to help patients, but to also raise awareness about the condition, so patients know what to expect and what strategies they can use to help manage the symptoms.
Deserved recognition
Dr Justin Roe (above), Joint Head of Speech and Language Therapy, has been awarded a fellowship of the Royal College of Speech and Language Therapists. He was commended for his excellence in clinical practice and international work to improve the care of people diagnosed with head and neck cancer.
Prestigious award
Dr Helen McNair, Lead Research Radiographer, has been named as UK and London Radiographer of the Year by the Society and College of Radiographers. Dr McNair said: “It’s both a privilege and humbling to represent radiographers in this way. I feel very proud that my colleagues nominated me.”
Celebrating research
The Royal Marsden celebrated International Clinical Trials Day on 20 May with displays and events to showcase research and the history of clinical trials. On the same day, the National Institute for Health Research launched Be Part of Research, which encourages the public to get involved in medical studies. Find out more at bepartofresearch. nihr.ac.uk.
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Q&A: ‘CHEMO BRAIN’ Occupational Therapist Tamsin Longley talks about her recent research into cancerrelated cognitive impairment, also known as ‘chemo brain’ Q What is cancer-related cognitive impairment? A Cancer-related cognitive impairment, or CRCI, is a side effect of cancer and the treatment of the disease, experienced by up to 75 per cent of patients. Symptoms of CRCI vary in severity, but patients find that their attention and memory can be affected, along with the speed at which they can process information. Up to 35 per cent of patients
will have these symptoms in the long term, even after they finish treatment. It can have a major impact on a patient’s quality of life, affecting their ability to work or even carry out everyday tasks at home. Q What is CRCI caused by? A It’s known by many people as ‘chemo brain’; however, CRCI is not purely linked to chemotherapy. In fact, a variety of treatments
“It’s important to not only establish a service to help patients, but to also raise awareness about the condition”
Q What have you done at The Royal Marsden? A Last year, thanks to funding from the Winston Churchill Memorial Trust, I completed a fellowship learning about CRCI from international centres and understanding what practices they have in place. Bringing this research back to The Royal Marsden, we have since established a specialist service for any patient who may need us to understand, combat and treat the effects of CRCI. We’ve also been talking to other London trusts to share knowledge and best practice about this undertreated area of cancer care.
Want to know more? To be referred to Occupational Therapy, please ask your medical team. Alternatively, call us on 020 7808 2830 (Chelsea) or 020 7808 3090 (Sutton) to book an appointment or for further information
BULLETIN
Therapy through play
Fast-tracking health tech
BLOWING BUBBLES Arts and crafts activities can help young patients process their treatment
? DID YOU KNOW?
A NEW PSYCHOLOGICAL support group has been launched at The Royal Marsden’s Oak Centre for Children and Young People in Sutton. Paediatric patients aged between seven and 12 can take part in the Bubble Group, which encourages them to explore their thoughts and emotions about their cancer journey in a creative and therapeutic way. The course includes arts and crafts that allow young patients to express themselves. For example, they can use the ‘anger wall’ by throwing wet tissue at a wall to relieve stress,
use sensory bottles for relaxation exercises, and create a ‘bag of worries’ to help them to process emotions. They can also learn skills such as mindfulness and deep breathing, and socialise with other children who are going through similar experiences. The course was created by the Paediatric and Teenage Psychological Support Service – which is funded by The Royal Marsden Cancer Charity – as part of the NHS’s Eat Drink Move initiative, which aims to encourage patients to adopt healthier lifestyles in hospital.
We provide specialist tuition in core subjects for older children in our Oak Centre for Children and Young People, helping them to sit exams while receiving treatment.
Friends’ party success The Friends of The Royal Marsden, Chelsea, warmly welcomed 400 guests to its biennial Summer Drinks Party, which took place in the Chelsea Gardener in May. Hosted by Countess Cadogan and organised by Wendy de Capell Brooke, the evening raised about £25,000 for the Friends, with the bulk of this going towards funding
two scalp-cooling units for the hospital’s Medical Day Unit. A jazz band and entertainers ensured that the evening – kindly sponsored by Rathbones – was a resounding success.
The NIHR Biomedical Research Centre (BRC) at The Royal Marsden and the ICR held its first Digital Dragons’ Den in May. Nine small and medium-sized enterprises (SMEs) from the health technology industry pitched their ideas to our expert panel and an audience of healthcare professionals and researchers from The Royal Marsden and the ICR. The event was held in partnership with DigitalHealth.London’s Accelerator, which aims to speed up the adoption of technology in London’s NHS. It provided a unique opportunity to find out more about the latest health technologies, from AI-based medical imaging software to wearable devices designed to remotely support and monitor patients. Those in attendance were encouraged to establish collaborations with SMEs, develop partnerships for grant applications and explore existing solutions to support the BRC’s research.
PARTY TIME Businesswoman Jayne Sutcliffe and celebrity chef Ainsley Harriott at the Friends’ event
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ON YOUR
SIDE
Cancer care at The Royal Marsden involves dealing with the side effects of treatment as well as the disease itself. We highlight some examples of how our specialists help patients to manage these adverse effects
THANKS TO SMARTER, KINDER CANCER TREATMENTS such as targeted drugs, immunotherapy and minimally invasive surgery, many of today’s patients will suffer fewer long-term or severe side effects than they might have done in the past. But when side effects of treatment do occur, The Royal Marsden has every angle covered. We don’t just treat the cancer, we treat the whole patient – and that includes fixing problems before, during and after treatment to give them the best possible chance of not only living longer, but also having a better quality of life.
ON THE UP Dr Assunta Albanese and five-year-old Frankie Cheek
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SIDE EFFECTS
Helping young patients overcome endocrine problems As a Consultant Paediatric Endocrinologist, Dr Assunta Albanese splits her time between The Royal Marsden and St George’s Hospital, treating children whose endocrine systems have been damaged by cancer treatment. “First, the cancer must be treated, then we’ll monitor the patient for one to two years before we address any problems,” she explains. “It’s very common for radiation treatment for brain tumours to affect the function of the pituitary gland, which helps control the levels of hormones in the body. This can result in delayed growth and issues around puberty. “We closely monitor height and growth, and confirm the diagnosis with a range of tests to see which hormones are lacking and therefore what we need to replace.” Five-year-old patient Frankie Cheek was diagnosed with a rhabdomyosarcoma in the nasopharynx in 2016. He underwent nine rounds of chemotherapy, followed by proton beam therapy in Oklahoma, USA. His mum Catherine says: “We were warned the radiation would affect his pituitary gland and therefore his growth, and that he’d lose the sight in his right eye. He didn’t grow at all for the two years after treatment. He turned five and was the size of a three-year-old. “Then we were able to start giving him a synthetic growth hormone, and he’s grown seven centimetres. We love it when we have to buy him new school shoes and trousers now! He’s having MRI scans every four months and is doing really well.” >
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Supporting head and neck patients after surgery Speech and language therapists play a pivotal role in the rehabilitation of patients with head and neck cancers who undergo complex surgical procedures. Our team has created a new service that supports the increasing number of these patients who have transoral robotic surgery (TORS) with the da Vinci Xi robot. The service is just one example of how the team adapts their working methods to ensure that patients see the best possible results, according to Grainne Brady, Clinical Lead for Speech and Language Therapy. She says: “We started working with [Consultant Head and Neck Surgeon] Professor Vin Paleri’s team to develop this service in 2017 when TORS was increasingly being used for our patients. The minimally invasive approach means the patient has the potential for a much better outcome than with traditional open surgery. “We meet the patient before their operation and explain what to expect after surgery, with regards to their ability to swallow and their speech. “Post-surgery, we work with the patient and set goals for them to achieve with us and on their own at home. We see them regularly for both speech and swallowing rehabilitation.” Patient Julie Gallagher had TORS last year after being diagnosed with relapsed throat cancer. She says: “I had part of my tongue removed, so swallowing was particularly difficult for me. I did four weeks of intensive physiotherapy with Grainne, where I tried lots of food in order to improve my swallow. “Grainne was very good and adapted my sessions so there was something more appealing for me to try. Nine months on, my speech is nearly there, and eating is getting easier.”
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SIDE EFFECTS
SKIN CARE Consultant Dermatologist Dr Chris Harland (left) helped Ifet Butt (below) overcome a rare rash
Treating troublesome skin conditions
SETTING GOALS Grainne Brady with TORS patient Julie Gallagher
One possible side effect of cancer treatment is a rash, as some drugs and antibiotics that are used to treat chemotherapyinduced infections can trigger reactions on the skin. Dr Chris Harland is one of three part-time consultant dermatologists who divide their time between The Royal Marsden and other trusts. He says: “The dermatology team assesses and advises on the more serious cancer drug rashes, and we’re often required to give an urgent opinion as to whether treatment should be stopped, modified or continued. “We also advise on the potential of cancer spreading to the skin, and work closely with the Skin Unit from diagnosis to treatment and follow-up.” Patient Ifet Butt underwent chemotherapy and radiotherapy after being diagnosed with cancer on the base of his tongue. The treatment was successful, but he later developed a rare skin condition that worsened and
severely affected his quality of life. When his condition didn’t respond to treatments tried by other dermatologists, he was referred to The Royal Marsden. “Biopsies confirmed it was a very rare rash – lichen planus – possibly as a late effect of the cancer treatment,” says Ifet. “Dr Harland invited me to attend a large meeting of dermatologists as my case was a bit of a mystery, and after 18 months we found something that worked. “Today, my skin is normal again – I am so incredibly grateful.” >
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SIDE EFFECTS
Identifying nutritional issues in GI cancer patients A new dietetics service for patients with gastrointestinal (GI) cancers aims to identify those who are at risk of losing weight during treatment at an earlier stage. In the pilot feasibility study, funded by The Royal Marsden Cancer Charity, a specialist dietitian was present in radiotherapy clinics to meet patients before, during and after treatment. The study found that 38 patients – who had oesophageal, pancreatic or lower GI cancers – lost significantly less weight than those who followed the standard treatment pathway. Jen Newman, Senior Specialist Dietitian, says: “Research has 16 RM magazine
shown that patients who lose a lot of weight during treatment tend to be those who have poorer outcomes, so taking a more proactive approach to assess patients’ nutritional problems early on has made a positive difference. “For example, we are able to identify those patients who would benefit from a prophylactic feeding tube. These are patients who would be at very high risk of struggling with their eating during treatment, and intervening earlier on will improve their outcome.” Patient Michael Clifford, 70, had radiotherapy after being diagnosed with oesophageal cancer.
He says: “When I came to the first clinic, I met the dietitian, who suggested the feeding tube. I refused at first, but came round to the idea when they explained the benefits. “I have now completely lost my ability to swallow, so the tube has been essential. If I hadn’t seen the dietitian that early on, I would have just suffered the side effects for longer before a tube was fitted.” RM
“Our more proactive approach has made a positive difference”
EARLY INTERVENTION Dietitian Jen Newman with patient Michael Clifford
IT HAPPENED TO ME
I’M A PROFESSOR OF MEDICAL ETHICS, BUT HAVING CANCER CHANGED MY BELIEFS ABOUT MEDICINE Deborah Bowman MBE, 49, breast cancer patient
Things I had written and spoken about for years as abstract ideas suddenly became real and complex. I learned that giving consent could be overwhelming, no matter how brilliantly the staff communicate. I found that no amount of evidence could remove the difficulty of living with uncertainty. I joined a clinical trial and saw the relationship between clinical and research ethics differently. Above all, I appreciated kindness – which was something I encountered a great deal of. I also work as a broadcaster, making programmes about the moral questions in medicine. I was fortunate to have the chance to make a programme for BBC Radio 4 called Patient Undone about how
“I quickly learned that no amount of clinical experience can prepare you for adapting to life with cancer”
I HAVE SPENT MY entire working life in medicine. As a Professor of Medical Ethics at St George’s, University of London, where I do research, teach students and junior doctors and work with clinical teams and patients, I have always believed that patients should have total control in decisions about their treatment. But in 2017, this belief was tested when I was diagnosed with stage 3 breast cancer.
I quickly learned that no amount of experience can prepare you for adapting to life with cancer. Throughout my treatment, my responses surprised me. I was both rational and emotional. I both wanted to know and to not know information. I was constant and changeable. Sometimes, I was taken aback by the way the arrival of a Royal Marsden envelope made me feel – like grenades on my door mat.
being a patient has changed me and my practice in clinical ethics. I talked to some of the clinicians whose care made such a difference to me and my thinking. It was broadcast for the first time on 16 April – exactly one year after I had surgery at The Royal Marsden. My hospital experience was transformative. All of the staff in the team who cared for me – including my clinical nurse specialist, surgeon, consultant oncologist, healthcare assistants, chemotherapy nurses, radiographers, allied health professionals and research nurses – demonstrated to me what ethical care looks and feels like in practice from the other side of the consulting room. I will always be grateful to every one of them. RM
Dr Mark Allen
Consultant Medical Oncologist “We see patients from all walks of life in our clinics, and it can sometimes be daunting for us as clinicians to meet a patient with a medical background. Usually, however, it becomes clear that despite any pre-existing knowledge, they share that same need for information and support as anyone faced with a new diagnosis of cancer. “With so much information about breast cancer and its treatment available from different sources, it is important to try to offer some sort of guidance, tailored to the individual patient and her cancer. We explain the reasons why we might recommend a certain course of treatment, or the pros and cons behind different treatment options, so that the patient can feel confident she is making the right treatment choice for her.”
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A DAY IN T HE L IF E OF
HONOR ATA CH A JECK A-S ZCZ YGIEL SK A SENIOR R ADIOTHER APY PHYSICIST
I’VE BEEN WORKING in the Joint Department of Physics at The Royal Marsden in Sutton for 10 years and am one of a team of physicists responsible for the quality control of our linear accelerators – machines we use to treat patients with radiotherapy. We have seven linear accelerators, or linacs, in Sutton and four in Chelsea. I work closely with engineers, radiographers and clinical oncologists to ensure the machines are safe and effective for patients. If a machine breaks down or develops a fault, an engineer will fix the problem and I’ll verify that it is delivering the precise dose of radiation before any patients are treated. This is key to ensuring that treatment is safe and effective. Working order Each linac has a detailed quality control check every month. When I sign my name in the log book to say that a machine is fit for clinical use, it’s a big responsibility, so our checks are extremely stringent. I’ll ensure that the dose levels are correct and the mechanics of the whole machine – from the devices that shape the beams of radiation to the bed patients lie on – are working. I’ll also check the imaging 18 RM magazine
A D AY I N T H E L I F E
“These machines are incredibly complex – you can’t just plug it in and put a patient on it” function of the linac, that the laser beams used to position the patient are aimed precisely at the specified point, and that the emergency stop buttons are working. Going forward, I’m trying to make quality control faster and digitise some of the processes. We’ll also test the individual treatment plans, which are produced by a physicist using computer software. They set out how many sessions – known as fractions – of radiotherapy a patient should have, the amount of radiation they should receive, and the angles and shapes of the beam. These plans are then signed off by the consultant.
We use dosimetry ‘phantoms’ to test the treatment plans and verify the radiation dose. These are essentially sophisticated mannequins and can contain more than a thousand separate radiation detectors. Test and plan When I’m not working with one of the linacs, I’ll be in the dosimetry lab. Here, I’ll analyse measurements, test our equipment and plan my next quality control system. I usually work standard office hours, but if we need to spend time on one of the machines when the Radiotherapy Department is busy, we’ll do our checks and testing in the evening. At the moment, we have a new linac we’re commissioning for use. These machines are incredibly complex – you can’t just plug it in and put a patient on it. We need to acquire all the radiation beam data required for treatment, enter it into
CHECK POINT Honorata’s role involves ensuring that The Royal Marsden’s hi-tech radiotherapy machines are safe and effective
a computerised treatment planning system, plan and verify numerous procedures and train all personnel. Although we don’t work directly with patients, I find commissioning a new linac so interesting. In fact, making sure that the machines are working to their highest specification is my favourite part of the role. RM RM magazine 19
T HE PURSUI T OF E XCELLENCE Thanks to new advances, The Royal Marsden is successfully treating gynaecological cancers in more patients than ever before THE GYNAECOLOGY UNIT at The Royal Marsden takes a multidisciplinary approach to treating patients with ovarian, cervical, womb, vaginal and vulval cancers. With an expert team including surgeons, medical and clinical oncologists, pathologists, radiologists and nurses, The Royal Marsden is a centre of excellence in gynaecological cancers. The primary treatment for many of these cancers is surgery. The Royal Marsden has pioneered robotic procedures – to date, our
PINPOINT ACCURACY Mr Thomas Ind (above); Mr John Butler with the PINPOINT imaging system (right)
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surgeons have carried out more than 700 robotically assisted operations – and the treatment of recurring cancers. “Robotic surgery offers patients less blood loss, pain and scarring, and shorter hospital stays, compared with open surgery,” explains Ms Marielle Nobbenhuis, Consultant Gynaecological Oncology Surgeon. Mr Thomas Ind, Head of the Gynaecology Unit and Consultant Gynaecological Oncology Surgeon, adds: “We’re at the heart of international discussions about how to train surgeons in robotic gynaecology surgery. We’ve seen the success of our Robotic Surgery Fellowship, funded by The Royal Marsden Cancer Charity, and more recently had a nurse join our unique Robotic Nursing Fellowship programme [see page 7].” Special expertise A key focus of surgical procedures performed at The Royal Marsden is on cancers that have recurred. This is a unique area of expertise, often
involving long and complex operations crossing multiple organ sites. Consultant Gynaecological Oncology Surgeon Mr Des Barton has established a team with specialists in other tumour types to carry out these procedures, which can sometimes be the last surgical solution for patients and, at present, the only hope for a possible cure. Mr John Butler, Consultant Gynaecological Oncology Surgeon, says: “Over the past decade, we’ve been increasing our repertoire of surgical procedures with the overall aim of removing all of the disease and improving patient outcomes and surgical precision. “PINPOINT is an exciting new device that offers highdefinition and advanced fluorescence imaging in real time during open and laparoscopic surgery. It will allow surgeons to identify and remove just the lymph nodes that are potentially affected by cancer, increasing the accuracy of the procedure and reducing complications such as lymphoedema. It will also allow >
GYNAECOLOGY UNIT
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LANDMARK RESEARCH Dr Susan Lalondrelle (left); Dr Susana Banerjee (below)
surgeons to look at blood flow for optimising bowel surgery.” Revolutionary results Historically, some gynaecological cancers have had a poor prognosis, but that is beginning to change. “We are seeing substantial progress in research,” says Dr Susana Banerjee, a Consultant Medical Oncologist whose research is generously supported by the Lady Garden Foundation. “Several new targeted drugs have been licensed in recent years, giving more treatment options that will improve survival rates.” The Royal Marsden recently participated in an international trial that demonstrated that the drug olaparib, a PARP inhibitor also known as Lynparza, could cut the risk of disease progression or death by 70 per cent in patients with newly diagnosed, advanced BRCA-mutated ovarian cancer. Dr Banerjee, co-author of this work, says that the “landmark” results represent a shift in how we should treat ovarian cancer. The unit is also focusing on understanding why some patients might be resistant to PARP inhibitors and exploring other treatment options. Royal Marsden patients will be the first in the world to trial the effectiveness of ATR inhibitors, a new treatment type that targets weaknesses in cancer cells, in a trial led by Dr Banerjee. The Gynaecology Unit works closely with the Cancer Genetics Unit to offer genetic testing to 22 RM magazine
at-risk patients – specifically those with the BRCA1 and BRCA2 gene mutations, which can increase a woman’s lifetime risk of ovarian cancer to 60 per cent. The Mainstreaming Cancer Genetics (MCG) programme, which began in the Gynaecology and Breast units, aims to provide faster and more efficient testing for these genes. Led by Dr Angela George, Clinical Lead for the Cancer Genetics Unit, the programme has benefited more than 2,000 patients. An additional advantage of MCG is that relatives with the BRCA mutation have the option of having ovaries removed now or after they have had children. “We predict this could prevent 283 cases of ovarian cancer and 77 deaths each year in the UK,” says Dr George. “It has revolutionised testing for women.” On target The Royal Marsden and its academic partner, The Institute of Cancer Research, have led the development of more precise radiotherapy techniques that offer kinder treatments for all patients with gynaecological cancers, whether treated here or further afield.
State-of-the-art technology means that our patients can benefit from innovations such as volumetric modulated arc therapy, stereotactic body radiotherapy and image-guided adaptive brachytherapy, led by world-leading Consultant Clinical Oncologists such as Dr Susan Lalondrelle and Dr Alexandra Taylor. Dr Lalondrelle, Lead for Radiotherapy, says: “The MR Linac – which combines MR imaging and radiotherapy – is useful for treating cancers that are hard to see with standard technology and hard to treat due to organ motion. We are the first department in the UK to use the MR Linac to visualise pelvic cancers and adapt daily treatments, and I am leading an international research consortium studying which gynaecological cancers we can treat most effectively.” Combining ultrasound and cone-beam computed tomography (CBCT) – an imaging technique used just before treatment – while treating tumours in the cervix has been the focus of recently published research conducted by Dr Lalondrelle and colleagues Dr Emma Harris and Dr Helen McNair. They found that this
GYNAECOLOGY UNIT
A PATIENT’S PERSPECTIVE Preeti Dudakia, 52
method made it easier to identify the target and normal tissue at the start of each radiotherapy session, and could potentially be used to deliver more accurate radiotherapy with less damage to healthy tissue. Emotional support Alongside research and surgical innovations, The Royal Marsden strives to provide the very best nursing care. “We wouldn’t be able to deliver an excellent standard of care for our patients without the work of our nursing teams,” says Mr Ind. The Gynaecology Unit includes a variety of dedicated nursing roles, including staff nurses, research nurses, clinical nurse specialists (CNSs) and advanced nurse practitioners (ANPs). CNSs offer emotional support, information and advice from diagnosis, throughout the course
of treatment and during follow-up. In gynaecology, this might include providing practical advice about the menopause, intimacy, body image, sexuality and fertility after patients have finished treatment. Jane Ash is one of the new ANPs on the unit, having been a CNS for 10 years. Her role means that patients have continuity of care and are seen more quickly. With her enhanced skills, she may be taking on more of the tasks that a specialist registrar might perform. She says: “I see patients from their very first stay in hospital through to their follow-up clinic – which means they really benefit from continuity of care. “It’s been hugely valuable to have experience as a CNS in this role. I have an understanding of the psychological needs of patients and know what support services they may benefit from.” RM
SURGICAL SOLUTION The primary treatment for gynaecological cancers is surgery, with robotic procedures increasingly commonplace
“I was 47 years old when I was diagnosed with stage 3 ovarian cancer. It had spread to my abdomen, so I had a full abdominal hysterectomy, followed by six cycles of chemotherapy. “My mum was diagnosed with ovarian cancer at the age of 60. Because of my family history, the team at The Royal Marsden recommended I try the SOLO-1 trial. “I had monthly treatment for two years, starting in late 2014, and now I’m in remission. Touch wood, the cancer isn’t coming back. “Since my diagnosis five years ago, there have been some rapid advances in treatment for ovarian cancer, and clinical trials like SOLO-1 are a crucial part of this. The trial gave me a sense of purpose and I know the findings will benefit patients for years to come.”
“Newly licensed drugs give more treatment options that will improve survival rates” RM magazine 23
IN OUR
DNA
While whole-genome profiling for childhood cancers remains the ultimate goal, young patients at The Royal Marsden are already benefiting from genetic tests
24  RM magazine
GENOMICS
– can handle more than 300 samples. This means that we can test paediatric cancer samples alongside those of more common adult cancers, which speeds up the return of results. Dr Hubank says: “NHS England has agreed that our panel can be run as well as whole-genome sequencing, so we now offer panel sequencing to paediatric patients with solid tumours across the country. “All of the samples are submitted to our Genomic Laboratory Hub partners at Great Ormond Street Hospital [GOSH] for processing and sent to our labs in the CMP for sequencing. We decide which sequencer to use depending on how many samples we have to run. Then we return the results to GOSH for clinical reporting.”
IN JANUARY, the NHS Long Term Plan set the goal of giving every child diagnosed with cancer access to whole-genome testing – and The Royal Marsden is leading the way. For several years, our researchers have run a bespoke genetic panel – a test that simultaneously analyses multiple genes – for our young patients. Determining the molecular profile of a patient’s tumour is key to helping our paediatric oncologists select targeted treatments. The panel, designed by scientists in the NIHR Centre for Molecular Pathology (CMP), tests 93 genes in paediatric solid tumours that have ‘actionable’ mutations that can be targeted with standard and experimental treatments. It was rolled out as part of a study to the 21 cancer centres that make up the Children Cancer Leukaemia Group (CCLG). Targeted treatments Dr Mike Hubank, Head of Clinical Genomics (Research) at The Royal Marsden and The Institute of Cancer Research, says: “The study tested more than 250 samples from around the country. The panel covered genetic mutations for which a targeted treatment was available or accessible via a clinical trial. “Whole-genome sequencing is an exciting option for the future, but it needs to show that it can offer a diagnostic solution for paediatric cancers. A whole-genome sequence includes all three billion bases of DNA, but we only have treatment options for a tiny proportion of the changes that might be found. We can fit all those actionable genetic variants on our 93-gene panel.” Dr Hubank’s team runs the paediatric solid tumour gene panel in the CMP on two DNA sequencing machines: the NextSeq 500 and the NovaSeq 6000, both made by Illumina. The NextSeq 500 can test up to 24 samples at a time, while the NovaSeq 6000 – funded by The Royal Marsden Cancer Charity thanks to a £1-million donation from the Denise Coates Foundation
Personalised care Over the past five years, genetics and genomics have helped consultants in the Oak Centre for Children and Young People match dozens of paediatric patients to targeted treatments. In particular, our Oak Paediatric and Adolescent Drug Development team has used gene testing to personalise experimental treatments for patients who have relapsed and for whom standard treatments no longer work. Dr Lynley Marshall, Oak Foundation Consultant Paediatric Oncologist and Head of the Oak Paediatric and Adolescent Drug
TEST AND LEARN The NovaSeq 6000 DNA sequencing machine (left); Dr Mike Hubank (above right); Dr Lynley Marshall (right)
Development team, says: “Genetic testing gives us more information about the tumour and what is causing the cancer cells to grow. Paediatric tumours generally have far fewer identifiable mutations than adult cancers, but this means that ones we do find are likely to be relevant. “For example, a BRAF or ALK mutation is what we would call a ‘driver’ mutation that is actionable with a targeted treatment. We may also find ‘passenger’ mutations that are present but probably not likely to be driving tumour growth.” The Royal Marsden recently recruited the first UK patient to the SMPaeds (Stratified Medicine Paediatrics) programme, which is analysing the molecular profile of tumours at relapse. SMPaeds will act as a molecular screening programme to diagnose actionable mutations, and will help direct patients with relapsed or resistant disease towards more personalised therapies and clinical trials. One example is the e-SMART European Stratified Medicine ‘basket’ trial, a multi-armed Phase I/II trial of molecularly targeted agents, often in combinations, that will shortly open in the UK. RM RM magazine 25
By George, they’ve done it!
MARCH IN MAY Supporters on the route (right); BBC presenter Bill Turnbull cuts the start ribbon (below)
Marching as one THE BANHAM MARSDEN MARCH went ahead slightly later this year, after the event was rescheduled due to high winds on the original date in March. On 19 May, almost 4,000 people walked between The Royal Marsden’s Chelsea and Sutton hospitals to raise money for The Royal Marsden Cancer Charity. Despite the change in plans, dedicated supporters raised more than £1.4 million to help patients and their families and friends, not just at The Royal Marsden but across the UK and around the world. Antonia Dalmahoy, the Charity’s Managing Director, said: “The response we received about rearranging the event was overwhelming and we were delighted to be able to reschedule it. “It was an amazing day, and I want to thank everyone who joined us to walk, volunteer or support their family and friends. I also want to thank those 26 RM magazine
supporters who were unable to make the rearranged date but organised their own walk in order to support the Charity. “We’re also incredibly grateful to Banham for their continued sponsorship.”
Want to know more? See more photos from this year’s Banham Marsden March and sign up for early-bird alerts for next year’s event at royalmarsden.org/march
George and the Giant Pledge – set up by Vicki and James ‘Woody’ Woodall when their son George was diagnosed with cancer in January 2017 at the age of four – has smashed its £1-million target to help The Royal Marsden Cancer Charity beat childhood cancer. The Woodalls hit the million mark as Vicki crossed the finish line of the 2019 London Marathon. Woody said: “It’s been amazing to have so much support from friends, family, colleagues and people we’ve never met to enable us to raise over £1 million in just under 30 months. We’re so proud to be able to help the Charity fund much-needed research into childhood cancer, and support other patients and families going through treatment.” Vicki and Woody have worked tirelessly, from selling George and the Giant Pledge capes to holding auctions, raffles and quiz nights, rallying troops for The Banham Marsden March, and updating their daily blog. In 2018, they were also named Google’s inaugural UK Charity of the Year. The money raised will go towards paediatric cancer research and support for children and their families.
Want to know more? Find out more about George and the Giant Pledge at giantpledge.com
T H E R O YA L M A R S D E N C A N C E R C H A R I T Y
IN THE RUNNING
TEAM MARSDEN Marathon runners Sophie Mackie (above) and Billy Hewlett (right)
SUPPORTERS TAKING PART in running events raised more than £888,000 for The Royal Marsden Cancer Charity in the past year – including £270,000 from the 2019 Virgin Money
London Marathon alone, when a team of 86 runners took to the streets of the capital. These marathon men and women included Billy Hewlett, son of the late broadcaster and
journalist Steve Hewlett, who was treated for oesophageal cancer at The Royal Marsden. “Dad would be so chuffed that I ran a marathon, and so proud that it was for The Royal Marsden,” said Billy. “The people are so kind and thoughtful – for me and my family especially, when you’re there day in, day out, the relationships you build with the nurses are unforgettable. I’m forever indebted to The Royal Marsden – and to be able to give something back is an honour.” Rachel Johnston, Senior Community Fundraising Executive, said running events are a fantastic way of raising money: “Our runners come from all backgrounds. Some are friends and family of patients, some are patients themselves, and some are dedicated runners who just want to support a good cause. “We are fortunate that a huge number of people secure their own places in events and choose to raise money for the Charity. This has seen us
represented in Melbourne, Rome and Chicago, and even the Sahara.” We’re looking for runners to join Team Marsden and raise money for the Charity in the Royal Parks Half Marathon on 13 October. The 13.1-mile race takes in four Royal Parks and passes London landmarks such as Buckingham Palace, Horse Guards Parade and the Royal Albert Hall.
Want to know more? Register your interest in the Royal Parks Half Marathon at royalmarsden.org/ royal-parks-half-marathon
Supporters brave the elements to raise money Some of our intrepid supporters truly go to extremes to raise money for The Royal Marsden Cancer Charity. In a trip involving uphill ski touring, downhill and 20 individual ascents, Lorna Robertson Timmis and Kate Burgin, alongside 13 others, ascended the equivalent of Mount Everest over four days in the Alps to raise £240,000 for The Royal Marsden Cancer Charity and the Brain Tumour Charity.
Lorna was diagnosed with breast cancer in 2008 and has been treated at The Royal Marsden for the past 10 years. She said: “Further funding is needed so more people like me are offered support and medical expertise for their entire journey and beyond, so that cancer can become a condition rather than a life-limiting disease.” John Matthews’ fundraising also had a wintry theme. He ice-skated
100 miles across the frozen Lake Khovsgol in Mongolia over four days, in temperatures as low as -40°C. He said: “My uncle Mick is being treated for an aggressive form of prostate cancer at The Royal Marsden. After he told me about how their pioneering cancer research and treatment are his best hope of survival, I knew I had to do something to help them continue their groundbreaking work.”
Contact The Royal Marsden Cancer Charity Telephone 020 7808 2233 Email charity@royalmarsden.org Visit royalmarsden.org Registered Charity No. 1095197 RM magazine 27
JOIN THE PLACE INSPECTIONS All hospitals providing NHS-funded care need to undertake an annual assessment of the quality of non-clinical services – and you could help us to do this. Patient-Led Assessments of the Care Environment (PLACE) aim to drive improvement by providing a clear message, directly from patients, about how the hospital might be enhanced. During PLACE inspections, teams of patient and staff assessors visit the hospital to evaluate how the environment supports the provision of clinical care. Areas of focus include privacy and dignity, general building maintenance, and the support of people with a disability or dementia. We are inviting members to take part in this year’s assessment, which takes place in the autumn. There will be several assessment teams and the time commitment will vary, depending on the areas assigned. You do not need any specific knowledge of healthcare to take part. Want to know more? If you’d like to be involved, please email trust. foundation@rmh.nhs.uk or call 020 7808 2844
28 RM magazine
RECRUITMENT AND ENGAGEMENT IN APRIL, GOVERNORS of The Royal Marsden held a Members’ Week to focus on recruiting new members and engaging with existing ones at the Trust. Activities took place at both Sutton and Chelsea, such as tours of the hospitals and visits to outpatient areas to meet patients and visitors in person. In addition, a drop-in session enabled patients and visitors to meet Governors and our Chairman, Charles Alexander, over refreshments. Some members used the opportunity to discuss the Council elections and find out more about the role of Governor.
Those who came to the session also had the opportunity to see the exciting plans for the new Oak Cancer Centre in Sutton and to find out about the work of The Royal Marsden Cancer Charity. Our Governors’ efforts during the week paid off as they recruited more than 200 new members. The Trust would like to thank all of the Governors and members for making Members’ Week a great success. Want to know more? If you would like to become a member of the Trust, please visit royalmarsden.nhs.uk/membership
MEETING MEMBERS Governors chat to the public during Members’ Week
F O U N DAT I O N N E W S
Dates for your diary Council of Governors meeting 31 July 2019, 11am-1pm, Chelsea Annual General Meeting 18 September 2019, 5pm, Chelsea Council of Governors meeting 24 September 2019, 11am1pm, Sutton
LEARNING MORE Chairman Charles Alexander (above) and NEDs Heather Lawrence and Martin Elliott (right) tour The Royal Marsden’s laboratories
UNDERSTANDING GENOMICS CHAIRMAN CHARLES ALEXANDER and other non-executive directors (NEDs) visited the main biochemistry laboratory, the NIHR Centre for Molecular Pathology and the McElwain building in Sutton in May to learn more about the work being undertaken in genomics and the role of new technology. NED Professor Martin Elliott said: “It was fantastic to see the amazing work being done in the
biochemistry and genetics labs on our tour. We were full of admiration for the dedication and drive for innovation shown by the staff. “New analysers and sequencing technology offer significant benefits for our patients and for the future of The Royal Marsden. Seeing them in use and hearing about their potential really helps us as NEDs to focus on what we can do as a board – not only to embrace
that technology and the future, but also to concentrate on making working conditions better for staff.” Another NED, Heather Lawrence OBE, said: “It was great to see the detailed and complicated analysis that the staff do to support accurate diagnosis and deliver the best treatment to our patients. Thank you so much to the staff for giving up their time to help us understand their work.”
FAREWELL AND THANK YOU A number of Governors have stepped down from their roles at the Trust this spring. In March, Governors Duncan Campbell, Lesley-Ann Gooden, Colin Peel, Mo Carruthers and Rachel Nabawanuka had their final Council of Governors meeting at the Trust before reaching the end of their term. We would like to express our sincere thanks
for their dedication and contributions to the Council over the years. Our thanks also go to former Governor Dr Andrew Pearson, who is unable to stand for re-election due to a recent illness. During his three-year term, Dr Pearson has made a significant contribution to the Trust and the Council.
Council of Governors meeting 4 December 2019, 11am1pm, Chelsea To attend any of these meetings, please call 020 7808 2844 or email trust. foundation@ rmh.nhs.uk
Keep in touch To contact your Governor, email governors@ rmh.nhs.uk or telephone 020 7808 2844. Sign up and become a member at royalmarsden. nhs.uk/ membership
RM magazine 29
PUZZLES & PRIZES
PRIZE CROSSWORD
SUDOKU
THE TEAM
Try the fiendishly tricky numbers puzzle – it’s just for fun
FOR THE ROYAL MARSDEN
4 9 3 9 8 6
Send your crossword with your name and contact details to RM, PR and Communications Team, The Royal Marsden, Fulham Road, Chelsea, London SW3 6JJ. The entry closing date is Thursday 15 August 2019. See below for prize draw rules. Spring 2019 crossword solution Across 1 Red squirrel 6 Tin 7 Anagram 8 Snail 9 Train 11 Spend 13 Bossy 15 Arrival 16 Oca 17 Front garden Down 1 Rates 2 Dan Dare 3 Quail 4 Inapt 5 Lemon 10 Abscond 11 Staff 12 Davit 13 Balsa 14 Yearn Congratulations to Rodger Whitfield, the winner of the spring 2019 issue’s crossword prize. 1
2
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SUMMER 2019 PRIZE CROSSWORD ENTRY FORM Fill in your details below when sending in your crossword competition entry. See above for details of our address. NAME ADDRESS
POST CODE TELEPHONE
30 RM magazine
7 4
9 4 1 7 1 7
3 7
8 6 6 1 3 9 4
Orla Anandarajah PR and Communications Assistant
FOR SUNDAY
CROSSWORD CLUES
5
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The lucky winner of our prize crossword will receive a £50 John Lewis & Partners gift card.
Rachael Reeve Director of Marketing and Communications Elaine Parr Head of PR and Communications Abby Samuel PR and Communications Manager Catherine O’Mara Senior PR and Communications Officer Hannah Bransden Senior PR and Communications Officer
Across 1 Lacking experience and judgement (5) 4 Bundles of hay (5) 6 Toy made from cloth (3,4) 8 Small body of water (4) 9 Repeat and summarise (5) 12 Italian sauce for pasta (5) 13 Girl’s name (4) 15 American mammal (7) 17 Flat bread (5) 18 Essential liquid (5)
Down 1 Daily or weekly publication (9) 2 Creates a new device (7) 3 Aristocrat (4) 4 Film star Humphrey ______ (6) 5 Astrological sign (3) 7 Inhabitant of northern Finland (9) 10 Peacefully happy (7) 11 Capital of Colombia (6) 14 Winter weather (4) 16 Baby’s bed (3)
PRIZE DRAW TERMS AND CONDITIONS 1. The Prize Draw is open to all readers of RM except employees of the Press Office at The Royal Marsden and Sunday, who produce RM magazine. 2. The closing date for receipt of all entries is Thursday 15 August 2019. Only one entry per person per draw. 3. Responsibility cannot be accepted for entries that are incomplete, illegible or not received. Proof of posting is not proof of receipt. No cash alternative is available and prizes are not transferable. Value of prize is correct at time of going to press. 4. Winners will be notified by post within 14 days of closing date.
5. The Promoter’s decision on any aspect of the promotions is final and binding. No correspondence will be entered into. 6. The Promoter reserves the right to substitute a prize of equal or greater value should circumstances make this necessary. 7. Entry implies acceptance of rules. 8. The winner of the crossword prize of a £50 John Lewis & Partners gift card will be the first correct entry drawn out of the bag. 9. The Promoter is The Royal Marsden, Fulham Road, London SW3 6JJ.
Marc Grainger Editor Mark Wheeler Art Director Sian Purdy Designer Gill Tait Account Director Richard Robinson Group Editor Matt Beaven Creative Director Toby Smeeton Managing Director
RM magazine is published by The Royal Marsden in partnership with Sunday: wearesunday.com © The Royal Marsden 2019. All rights reserved. Reproduction in whole or part is prohibited without prior permission of the Editor. The Royal Marsden and Sunday accept no responsibility for the views expressed by contributors to the magazine. Repro by F1 Colour. Printed by Pureprint.
S TAY I N T O U C H
COMMENT, LIKE, SHARE Join the conversation on Twitter @royalmarsden and @royalmarsdenNHS Facebook @royalmarsden, @royalmarsdenchelsea and @royalmarsdensutton Instagram @royalmarsden Twitter LAUREN MAHON | LOZZA @iAmLaurenMahon Yesterday team #YouMeBigC headed to the @royalmarsden to hold our girl @bowelbabe’s hand for surgery – and record a pod. Naturally. Whilst the wife was under @blandsteve @MikeHolt12 + I were granted access to see the Da Vinci Xi in action. It was an absolute privilege. Thank you Priscilla Harries @Cilla_Harries So special to celebrate Professor Martin Gore’s life today – he was an inspiration and mentored so many including my husband to become an oncologist
Franky @frankymaryjane 5yrs ago today I was undergoing a hysterectomy at @royalmarsdenNHS! Where have the past 5 yrs gone?! So grateful for @ThomasInd & amazing team at @royalmarsden Happy 5 Year #hysterversary to me [above]
Adam Obee The amazing work you guys do is indescribable. 17 months ago, my dad was told he had 2/3 months to live. He underwent emergency chemo... In April my dad was given an all clear and is currently in remission. I still have my dad. My best friend. My hero. And I can’t thank you all enough. Laura Patton We are grateful for all my son’s clear scans at the Marsden this year. After battling Synovial Sarcoma with the best army behind him, my son has now been cancer free for 18 months. Thank you so much xx
Instagram Georgie Swallow @georgieeswallow Holy Macaroni & Cheese! £10,835 is the final amount raised for @royalmarsden from my fundraising throughout chemo I can’t put into words how grateful I am... it means more than you can imagine [above].
CONTACT US CALL THE ROYAL MARSDEN, CHELSEA
020 7352 8171
CALL THE ROYAL MARSDEN, SUTTON
CONTACT THE ROYAL MARSDEN HELP CENTRE For confidential chat, support and information, call
020 8642 6011
0800 783 7176
VISIT US ONLINE royalmarsden.nhs.uk
or visit royalmarsden.nhs.uk/your-care/ royal-marsden-help-centre
WANT TO WORK AT THE ROYAL MARSDEN? Visit jobs.royalmarsden.nhs.uk READ RM MAGAZINE ONLINE royalmarsden.nhs.uk/rm-magazine
For general feedback, compliments, concerns or complaints, send us a message royalmarsden.nhs.uk/ contact-us/get-in-touch
STAY IN TOUCH WITH THE ROYAL MARSDEN CANCER CHARITY CALL US
020 7808 2233 EMAIL US charity@royalmarsden.org VISIT US ONLINE royalmarsden.org Registered Charity No. 1095197
Look out for the autumn 2019 issue of RM – coming September 2019 RM magazine 31
the future Leaving a gift to The Royal Marsden Cancer Charity in your Will can transform the lives of countless people who are touched by cancer. A gift of any size will help us pioneer life-saving research and develop the best treatments, making a lasting difference to patients long into the future. See the difference your gift can make. Visit royalmarsden.org/giftsinwills
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