Working collaboratively to improve blood cancer care
Dr Piers Patten and Dr Matthew Streetly, both Consultant Haematologists at Guy’s and St Thomas’ and King’s College Hospital NHS Foundation Trusts, blog about their respective specialisms and how collaborative working across our partnership is improving the way we care for people with blood cancer.
Blood cancers like leukaemia, lymphoma and myeloma are the third biggest cause of cancer deaths in the UK. However, blood cancer symptoms can be hard to recognise as they are often vague and similar to other diseases. We’ve worked together across our hospitals as part of the King’s Health Partners Haematology Institute to develop and promote a Joint GP Referral Guide for Adult Haematology which will help GPs decide when to refer for specialist help. We’re following this up with a series of GP education events, after a survey revealed that our local GPs would like to feel more confident in this area. We hope that this will be the beginning of a dialogue with our local GPs so that we can work together to find ways to detect and diagnose blood cancers earlier.
As co-chairs of the Blood Cancers Tumour Group, we’re also working together with partners across South East London to collaborate on improving aspects of care right through from diagnosis to how we care for people living with and beyond cancer. This will be further supported with the release of the new Pan-London guidelines for management of haematological malignancies. The new guidelines have been written to help clinicians in our network follow clear, consistent and evidence-based referral pathways for patients with blood cancers. In doing so we will able to provide more consistent approaches to treatment and reduce unwarranted variations in care, ultimately helping to improve patient outcomes on a wider scale.
Dr Matthew Streetly: caring for people with myeloma
I specialise in treating myeloma and related plasma cell disorders. Myeloma is a cancer of the plasma cells (white blood cells which produce antibodies), and is the second most common blood and bone marrow malignancy. Although it mainly grows in the bone marrow and bones it can cause many different problems including fractures, infections, anaemia, kidney failure, spinal cord compression and high calcium levels. It is often not suspected and has been identified as one of the cancers with the longest time from onset of symptoms to diagnosis.
Raising awareness of the problems it causes, what investigations to undertake and the importance of early specialist referral will help to identify the disease in patients earlier. It is currently not curable – but compared to when I started working in this field nearly 20 years ago the treatment options we can offer and the outcomes for people diagnosed with myeloma have been transformed. Myeloma survival has quadrupled in the UK in the last 40 years and the last 15 years has seen the introduction of multiple novel therapies (these include: lenalidomide, pomalidomide, daratumumab, bortezomib and panobinostat) that target the biology of the cancer resulting in better disease control and more tolerable side effects. A third of patients will now survive at least ten years from diagnosis and this proportion is increasing year on year. At Guy’s and St Thomas’ and King’s College Hospital NHS Foundation Trusts we have been fortunate to have been involved in some of the pivotal clinical trials that have contributed to these improvements. Our expectation is that this progress will continue with the exciting introduction of new immune- and cellular therapies that promise even better long-term control of the disease and possibly even a cure.
We already collaborate closely with hospitals across King’s Health Partners, and we work across multiple sites to plan our research and ensure patients have access to the right clinical trials.
Dr Piers Patten: caring for people with lymphoma
I specialise in seeing patients with lymphoma, a cancer of the lymph nodes, the fifth most common cancer in the UK and the most common blood cancer. I am particularly interested in patients with a common subtype, called chronic lymphocytic leukaemia (CLL). This is usually diagnosed from a blood test but it actually involves the blood, bone marrow and lymph glands. CLL often doesn’t need treatment, and patients are managed using a ‘watch and wait’ strategy which can cause worry in itself. We therefore strongly believe in educating and supporting patients even when no specific anti-leukaemia treatment is needed. When treatment is needed (and in some patients it never is) we have traditionally given a combination of chemotherapy drugs with an antibody infusion. This works very well, but in a few patients, the disease will nearly always come back. The antibody (generally ‘rituximab’ but newer ones such as ‘obinutuzumab’ are being used) specifically recognises the CLL cells by recognising a molecule known as CD20. However, the treatment of CLL is very rapidly changing and increasingly we are not using traditional chemotherapy at all.
Many new orally available drugs (for example ‘ibrutinib’ and ‘venetoclax’) have replaced chemotherapy both when we treat patients for the first time and also when the disease relapses. Although we already know that these new drugs are very effective at controlling the disease, we are currently participating in clinical trials that are examining the best way to use these drugs in combination. In the future, we hope to be able to treat patients only for a defined period with the expectation of controlling their disease for many years, completely transforming the outlook of patients with this common type of blood cancer.
As part of our Haematology Institute, we are exploring ways in which we can support people who are on ‘watch and wait’ regimes better. At the moment people attend hospital regularly for routine outpatient appointments and blood tests so that we can monitor their disease. We are working to improve care and reduce travel and waiting times by offering the choice to have blood tests done closer to home and discussing results by telephone or video, as well as supporting patients to monitor symptoms themselves and flag any concerns.
The King’s Health Partners Haematology Institute is aiming to bring together our strengths in clinical service, research, and education to deliver exceptional outcomes for haematology patients. Our vision is to develop cures and vaccinations for haematological conditions so that future generations do not have to face lives with these diseases.