Event Summaries

In March, the Yorkshire Cancer Research Bowel Cancer Improvement Programme held the 2024 Update Event to share the progress of the programme over the past twelve months.  This event was held online on zoom.

Topics included:

• Utilising Implementation Methodologies within BCIP
• Frailty work across the workstreams and setting new metrics for the Programme
• Quality Performance Measures
• Ethnicity and Colorectal Cancer
• Understanding local and national variation in the use of radiotherapy
• Using new methods to understand radiologists' view of changing practice
• Update on molecular testing for bowel cancer

A copy of the programme for the event can be accessed here: 2024 YCRBCIP Update Event outline Programme

A recording of the event can be accessed here:Zoom recording of the 2024 YCRBCIP Update Event

As part of the YCRBCIP, the Radiology workstream held two lunch and learn sessions in September 2023.  These  hour long sessions focused on the outcomes and findings from the BUSGAR audit on CTC and what we can learn from them for the CTC services in Yorkshire.  The learning objectives for the sessions were:

1. To understand the background and key priorities related to the RCR/BSGAR CT Colonography pathways guidance from 2023
2. To know the key performance requirements for services related to CTC quality assurance in RCR/BSGAR guidance from 2021
3. To know the current performance levels of CTC performance from national audit in 2019

Recording of the Radiology Lunch and Learn Event on 13th September 2023

Recording of the Radiology Lunch and Learn on 26th September 2023

Zoom Recording of Pathology Event 21 April 2023

This two-hour online educational event was open to any histopathologists or trainees with an interest in reporting colorectal cancers. This event included presentations from Professor Phil Quirke and Dr Nick West on the following topics:

• An overview of the Pathology Workstream and the YCRBCIP and its achievements
• Changes to the new Royal College of Pathologists Colorectal Cancer Dataset
• The rationale for multigene panel testing and the testing of YCRBCIP consented patients

Zoom Recording of YCRBCIP Annual Update 2023

The Annual Update on the Yorkshire Cancer Research Bowel Cancer Improvement Programme (YCRBCIP) was held on 24th January 2023.  The purpose of this event was to give colleagues across the Yorkshire and Humber region an update on the progress and achievements of the YCRBCIP over the last twelve months.

The presentations for this event included:

• The latest key data metrics used by the YCRBCIP
• How the patient voice has been included in the work of YCRBCIP
• Results from surgical audits
• Updated results from the post colonoscopy completion rate audit
• How the YCRBCIP has developed the implementation workstream and demonstrated change
• The development of the frailty workstream

Zoom recording of colonic cancer surgical event

This event was open to all colorectal cancer surgeons and surgical trainees in the Yorkshire and Humber region.

The event started out identifying the issues in relation to colonic cancers with presentations from;

• Nick West on the variation in outcomes based on the evidence in surgical specimens
• Jim Tiernan on the variation in surgical outcomes looking at post-operative CT.

The next section of the event focused on possible management solutions with presentations from the following;

• Thilo Wedel on Surgical anatomy revisited for right hemicolectomy with complete mesocolic excision
• Danilo Miskovic on Taking up the anatomical challenge for radical colonic resections using modern imaging and surgical techniques
• Damian Tolan on Appropriate selection of cases for pre-operative chemotherapy using CT imaging
• Dion Morton on Results from the FOxTROT study. Do surgeons need to be worried

Zoom Recording of Lynch Syndrome Education Event

There were some links that were suggested as part of the presentations;

Requesting genetic testing

NICE Guidance: Molecular testing strategies for Lynch syndrome in people with colorectal cancer

NICE Guidance: Testing strategies for Lynch syndrome in people with endometrial cancer

National Genomic Test Directory

UK Cancer Genetics Group Leaflets and Guidelines

Prospective Lynch Syndrome Database (PLSD) - cumulative risk for cancer by age, genetic variant, and gender in carriers subject to colonoscopy

This event was aimed at nursing teams across the Yorkshire and Humber region who care for cancer patients who should be tested for Lynch Syndrome and deficient mis-match repair (dMMR) status as part of their routine care; primarily those with colorectal cancer or endometrial cancer.

Presentations included;

• Patient Pathways for Lynch Syndrome from Referral to Results – Clinical Genetics
• Testing for Lynch Syndrome and dMMR before referral to Clinical Genetics Services
• Lynch Syndrome and dMMR the impact on treatment options
• Lynch Syndrome: the patient’s perspective

Lynch Syndrome – Hidden in Plain sight

This a patient editorial published alongside the paper Lynch Syndrome screening in colorectal cancer: results of a prospective two-year regional programme validating the NICE diagnostic guidance pathway across a 5.2 million population.
Authors – Katie McSweeney and Emily Boldison

Zoom recording of Anaesthetics/ Sprint Audit Results Event 20 May 2022

This event was open to all colorectal surgeons, anaesthetists involved in the care of colorectal cancer patients within the Yorkshire and Humber area.  Trainees who supported the audit and those interested in the results of the audit were also welcome to attend.

This event focused on sharing the results from the regional sprint audit from the surgical and anaesthetics workstreams. The audit focused on pre, intra and immediate post-operative care for patients with colorectal cancer.

Presentations at the event included;

• Overall results from the audit
• Key areas where significant variation has been identified for surgeons and anaesthetists
• Forthcoming frailty work
• Forthcoming work on multimodal analgesia and opioid stewardship
• Discussion about the audit results and actions to take place following the audit

Zoom Recording of Radiology Rectal MRI Event 18 May 2022

This event was open to radiologists and radiology trainees across the Yorkshire and Humber area.  Presentations at the event included;

• The outcome of the regional re-audit around rectal MRI
• Quality Assurance of MRI
• Lessons learned from the international TNM8 implementation work

At the event a number of key documents and papers were discussed.  These are available here;

Lambregts 2022 Current Controversies in TNM for the Radiology staging of rectal cancer

Schaap BJS 2021 Rectal cancer lateral lymph nodes

RCR National Rectal Cancer IMRT Guidance 2021

Colorectal Disease - 2021 - Hazen - Evaluation of the implementation of the sigmoid take‐off landmark in the Netherlands

Recording of Total Neoadjuvant Therapy Event

This was a multidisciplinary event across the oncology, surgery and radiology workstreams.  This event included presentations on:

• The evidence base for Total Neoadjuvant Treatment
• Selecting patients for TNT with imaging
• Agreeing the patient selection for TNT in the YCRBCIP region
• Pelvic Side Wall Nodal Dissection – who should receive this treatment

This event provided an opportunity to review the latest trial evidence for Total Neoadjuvant Treatment and Pelvic Side Wall Nodal Dissection.

Following a presentation of cases and polling of the event attendees the meeting developed a consensus of which patients should be managed with Total Neoadjuvant Treatment.  The outcome of the event will be a consensus treatment algorithm around TNT.  In addition, there was consensus about an approach to referring patients for review by a specialist panel of patients who may be suitable for pelvic side wall nodal dissection; the referral details and criteria will be circulated to teams across the region.

Zoom recording of 6th Pathology Event

This event was open to all histopathologists and trainees in the Yorkshire and Humber region with an interest in or reporting colorectal cancer.  Histopathologists with an interest in or who report on gynaecology cancers were welcome to attend the first half of the event to understand the results from the endometrial cancer Lynch testing

Topic/Themes covered during the event:

• YCRBCIP Update
• Final results from the endometrial Lynch screening testing undertaken via YCRBCIP
• Colon Cancer Surgery quality assessment
  • what have we learned from rectal cancer quality control?
  • what are the variables in colon cancer specimens?
  • what is the evidence that optimal colon cancer surgery matters
  • what is the current state of colon cancer surgery across the region
• Plans for YCRBCIP multigene panel testing and sharing of the results

Zoom recording of the Reducing Post Colonoscopy Colorectal Cancers

This event was open to all gastroenterologists, colorectal surgeons, nurse endoscopists, nurse practitioners, business managers, trainees, managers and endoscopy administration teams.

This was the inaugural event for the gastroenterology workstream that was formally launched in January 2021.

Speakers included Dr Roland Valori, Professor Matt Rutter, Dr Nick Burr, Dr James Turvill, Dr Chris Healey.  The programme for the event included;

• About the Yorkshire Cancer Research Bowel Cancer Improvement Programme
• National Audit of Post Colonoscopy Colorectal Cancers
• Outcomes from the PCCRC Pilot and Regional Data
• Quality standards in endoscopy and PCCRC
• National Endoscopy Database

A recording of the zoom event is available here:  YCRBCIP PCCRC Event Recording

Zoom Recording of YCRBCIP Update Event 31 January 2022

On 31st January 2022 we held an online event to provide an update on the Yorkshire Cancer Research Bowel Cancer Improvement Programme (YCRBCIP).   Presentations at the event included;

• The outcomes and work achieved to date by the YCRBCIP
• A tribute to our patient co-investigator, Barbara Hibbert
• Update from Yorkshire Cancer Research
• the impact of COVID on colorectal cancer services
• Results from the Lynch testing conducted by the YCRBCIP
• DPYD Testing in the YCRBCIP region
• The difference data can make to clinical teams
• Headline results from the 2021 anaesthetics and surgical audit
• Changes to MRI practice across the region
• Plans for the YCRBCIP for the next 12 months

This event was held via zoom and a recording of the event is available to view here; YCRBCIP Early Rectal Cancer Event Recording

Presentations from this event included:

• Setting the scene based on the Bradford Experience - Amarvir Bilkhu, Surgical Trainee,Bradford Teaching Hospitals NHS Foundation Trust
• Why we need endo-rectal ultrasound, Ragu Vinayagam and Naeem Jagirdar, Consultant Radiologists, Bradford Teaching Hospitals NHS Foundation Trust
• Why MRI is all that is needed, Damian Tolan, Consultant Radiologist,Leeds Teaching Hospitals NHS Trust
• Standardise/ Quality Assurance of Resection Specimens, Phil Quirke, Head of Pathology and Tumour Biology, University of Leeds
• Non-Surgical Oncology, Amandeep Dhadda, Consultant Clinical Oncologist, Hull University Teaching Hospitals NHS Trust
• YCRBCIP Early Rectal Cancer Minimum Dataset, John Taylor, Research Statistician, University of Leeds
• Videos of Resections/ Technical Aspects of Local Resections, Mark Steward/ Jon Robinson, Consultant Colorectal Surgeons, Bradford Teaching Hospitals NHS Foundation Trust

Workstream - Surgical workstream

Event Title - Peri-operative care, risk stratification and optimisation of patients for major surgery

Date – 24^th November 2017

Topic/Themes covered during the event:

• CPEX Testing and VE/VCO2 as Predictors of Survival
• Frailty in Surgical Patients
• Radiological Assessment of Sarcopenia in Surgical Patients and the Influence on Surgical Outcomes
• Post-Operative Care and Monitoring
• Routes to Diagnosis in Yorkshire & Humber
• Changing Management, and Influence on Outcomes in Colorectal Cancer- the Danish Experience
• CREST Trial Outcomes
• Post-Operative Care and Facilities across the region – outcome of the audit by ACPGBI.

Outcomes:
The event had two main outputs;

• A proposal to develop an anaesthetics workstream for the Bowel Cancer Improvement Programme.
• MDTs to confirm three priority areas of focus to develop new areas of analysis for the Programme

Workstream - Surgical workstream

Event Title - The Management of Early Rectal Cancers

Date – 10th October 2018

Topic/Themes covered during the event:

• Background to organ preservation including completed and planned trials
• Current regional picture using data from CORECT-R
• Radiological Staging of Early Rectal Cancers
• Pathology - Perspective on the nature of ‘early rectal cancer’ and quality issues around local excisions
• The Bradford experience on local treatment of early rectal cancer
• The rationale for considering non-surgical treatments based on experience of chemoradiotherapy for advanced rectal cancer
• An Endoscopist’s perspective on what to do if early rectal cancer is seen and what is the ‘scope’ of endoscopic management

Outcomes:

Some key areas for future discussions around the management of early rectal cancer forward were identified;

• Consideration of the development of a register for early rectal cancers to make sure the data is available for analysis
• Look at the pathways across the region and utilise the expertise,
• The development of a regional cohesive strategy for organ preservation
• The need to link with the other workstreams to support the initiatives in improving the quality of radiology and pathology reporting and data flows to ensure robust data.
• To focus on standardising high quality practice rather than changing existing patient flows

Workstream - Pathology workstream

Event Title - TNM8 and Tumour Deposits

Date – 10th October 2017

Topic/Themes covered during the event:

• TNM8 - working in practice
• Tumour deposits
• Optimising Lymph Node Yields
• Regional Audits:
  • Lymph Node Retrieval
  • Quality of Resection Reporting
  • Quality of Surgery via Specimen Photography

Outcomes:

Following the discussions during the event the following outputs were agreed by the regional pathologists;

• A Letter to commissioners to encourage regional funding of lynch immunohistochemistry for bowel cancer patients.
• The sharing of the methodologies in use across the region and in Denmark to enhance lymph node retrieval.
• The sharing of common issues encountered once TNM8 is implemented in January 2018 to enhance and improve reporting across the region.

Workstream - Pathology workstream

Date – 18th May 2018

Topic/Themes covered during the event:

• pT1 cancers
• Feedback from the Pathology Audits
• Lynch Screening and molecular pathology
• Lessons from the implementation of TNM8

Outcomes:

As part of the evaluation delegates were asked to identify what aspects from the day they would take back to their organisation or clinical practice. The most common items identified were:

• information around MMR testing and lynch screening.
• clarification of TNM8.
• macroscopic and integrated reporting.

Workstream - Pathology workstream

Date – 1st March 2019

Topic/Themes covered during the event:

• Low rectal cancers – including Mercury II results, assessment of specimens and group workshop using photographs from the YCRBCIP quality of surgery audit.
• Collection of tissue – sharing the progress with the YCRBCIP tissue block collection from the consented aspects of the study and the planned analyses.
• TNM8 and reporting issues
• Lynch screening and molecular pathology – including an update on the national genomics reconfiguration and practical guidance for dMMR and lynch testing for when the YCRBCIP funded testing ends.
• Feedback on the specimen quality audit – including some tips on how to improve specimen photography.

Outcomes:

In addition to topics for the next event, the clinicians in attendance determined the next steps and follow-up actions;

• Next pathology event should include a workshop session on colonic cancer including photographs from the specimen audit and assessment of mesocolic grading.
• Share the photography of specimens with the surgical workstream lead for inclusion in the surgical APE event.
• Discuss TNM8 implications with the oncology workstreams to understand what impact it is having on discussion of treatment options and feedback to pathology teams.
• Review the low rectal cancer in light of discussions and comments during the event; including review against screening data, rurality of patients and whether this has an effect on surgery.

Workstream - Radiology workstream

Event Title - MRI Training Event

Date – 21st January 2019

Topic/Themes covered during the event:

• Presentation of the results of the radiology reporting audit and the radiology users regional survey
• The limitations of rectal MRI
• Optimising the scans
• Learning from the Dutch experience

Outcomes:

Following discussions during the plenary session at the event the following next steps and follow-up actions are in development;

• Repeat the Radiology MRI Training event to allow for more radiologists and radiographers from across the region to attend.
• Revise a reporting template in response to comments made at the training event and circulate.
• The analysis of the templates completed in the training sessions of this event will be shared and discussed at the next event.

Workstream - Clinical Oncology

Event Title - Timing of Radiotherapy and Surgery for Rectal Cancer: Regional Variation and Implications of Stockholm 3

Date – 7th July 2017

Topic/Themes covered during the event:

• Timing of Surgery following Radiotherapy  and the variation across the Yorkshire and Humber Region
• Stockholm 3 and the Implications for the Yorkshire and Humber Region
• Developing a Regional Consensus
• Harmonising Radiotherapy Protocols Across the Region
• Updating the Consent Process

Outcomes:

• The output of the event was to agree the expanded areas of analysis of the radiotherapy data to determine reasons underlying the regional variation in the timing of surgery following radiotherapy.
• A sub-group was developed with representatives from the three regional radiotherapy centres to take forward work in agreeing consistent information to be provided to patients at consent.

Workstream - Clinical Oncology workstream

Date – 3rd August 2018

Topic/Themes covered during the event:

• To develop a consensus view on the timing of surgery following radiotherapy for patients with rectal cancer.

Outcomes:

Following a review of evidence the workstream has confirmed that across the Yorkshire and Humber region the clinical oncology opinion is that intervals between radiotherapy and planned surgery for rectal cancer should be as follows;

• Short Course and Immediate Surgery – 7 days from the end of radiotherapy
• Short Course and Delayed Surgery – 6-8 weeks following the end of radiotherapy

Next Steps: Confirm these discussions with surgical colleagues and once agreed implement within the MDTs across the region.

Workstream - Medical Oncology workstream

Date – 26th January 2018

Topic/Themes covered during the event:

• Overview of the Yorkshire Cancer Research Bowel Cancer Improvement Programme
• MMR Testing Facilities in Leeds – Progress Update
• Recruitment Following Ethics Approval for PROMS and Tissue Collection
• Update on SACT and Other National Datasets
• Active trials including Add-Aspirin, Focus 4, e-RAPID, Early Phase Bio-marker Trials
• SCOT and IDEA Data
• NICE Guidance on MMR Testing
• SIRT
• SABR
• Potential Impact on Service if FOxTROT is Practise Changing
• Radiotherapy Studies

Outcomes: 

• Oncologists to review the SACT data presented at the meeting within their hospital teams and forward comments to develop the analysis to the Programme team
• Agree a consistent regional policy for the prescribing of 3/6 month chemotherapy in line with the outcomes highlighted by the SCOT and IDEA data.

Workstream - Colorectal Clinical Nurse Specialist workstream

Date – 29th June 2017

Topic/Themes covered during the event:

• Remote Follow-up – The Approach in York
• Recovery Package - Regional Approaches, Challenges and Successes
• Update on PROMS work
• Rotherham Palliative Pathway

Outcomes:

Key gaps in knowledge of the new model were identified for cancer alliance across the region and determined this for a future topic for the next event.

Workstream - Clinical Nurse Specialist workstream

Date – 15th December 2017

Topic/Themes covered during the event:

• Introduction to the Yorkshire Cancer Research Bowel Cancer Improvement Programme
• PROMS and the YCR BCIP
• Good Clinical Practice
• Consent & the YCR BCIP Consent Process
• The YCR BCIP site set-up and recruitment

Outcomes:

• Circulating the capacity and capability documentation to research and development teams for completion
• Identifying suitable dates for site visits for team preparing to start recruitment

Workstream - Colorectal Clinical Nurse Specialist workstream

Date – 26th January 2017

Topic/Themes covered during the event:

• Re-establishing a colorectal CNS network
• The development of Projects and Priorities
• Introcution of the PROMS and Tissue consent aspects of the YCR BCIP
• Identifying the challenges in the PROMS and tissue consent process

Workstream - Radiology workstream

Date – 28th February 2017

Topic/Themes covered during the event:

• An outline of the YCR BCIP
• The national perspective of radiology for colorectal cancer
• Setting the regional priorities and proforma reporting

Outcomes - 

The following workstream priorities were identified:

• Creation of a network of radiologists with an interest in colorectal cancer across Yorkshire and Humber
• Introduction of proforma reporting minimum dataset for rectal cancer reporting across Yorkshire
• Standardisation of frequency of post treatment CT follow-up scans for colon across Yorkshire
• Standardisation and improvement of radiographers scanning techniques for rectum and colon
• Development of uniform criteria for nodes
• Creation of a difficult case facility for continuing professional education

Workstream - Surgery workstream

Date – 17th March 2017

Topic/Themes covered during the event:

• Outlining the Concept of the Bowel Cancer Improvement Programme
• Cancer Outcomes Services Dataset Local Reporting - where we are now
• Update on Regional Colorectal Surgical Data and Variation between Trusts
• Concept of Quality Performance Indicators

Outcomes:

The following workstream priorities were identified:

• Timely feedback of appropriate high quality data, to include quality performance indicators, to MDTs
• Reduction in perioperative 30 day and 90 day mortality
• Improvements in management of the elderly patient
• Standardised and enhanced treatment of early disease
• Improvement in the quality of surgery in both rectal and colonic surgery.

Workstream - Clinical Oncology workstream

Date – 17th March 2017

Topic/Themes covered during the event:

• Outlining the concept of the Bowel Cancer Improvement Programme
• Review of Current Radiotherapy Protocols
• Patient Consent – What do we do now and developing a consensus
• Variation in practice including radiotherapy data
• Developing IMRT Solutions for Rectal Cancer
• Round Table Discussion on Organ Preservation

Outcomes: 

The following workstream priorities were identified:

• Development and implementation of Yorkshire region standardised radiotherapy protocols
• Review and develop standardised patient information to support the consenting patients for radiotherapy.
• Understanding the impact of delay between short course radiotherapy and surgery and development of consensus approach across Yorkshire.
• Development of an IMRT protocol for rectal cancer

Workstream - Pathology workstream

Date – 28th February 2017

Topic/Themes covered during the event:

• Outlining the Concept of the Bowel Cancer Improvement Programme
• Where are we now in Pathology? – Regional and National Perspective
• Cancer Outcomes and Services Dataset Data Entry
• Specimen photography to Audit the Quality of Surgery
• Molecular Testing (Lynch syndrome and targeted therapies)
• TNM8 and Tumour Deposits
• Setting the Project Priorities

Outcomes - 

The following workstream priorities were identified:

• Enhancing full pathology staging across Yorkshire using COSD and additional datasets
• Photography of specimens to determine baseline quality of surgery across the region.
• Support for Lynch syndrome testing across the region until supported by Commissioners
• Support for pre-entry testing of patients into targeted therapy trials
• Enhanced pathology reporting across the Yorkshire Region