Section of Oncology Newsletter (Feb 2011)

On 1 January, I took over as Chairman of the Section of Oncology, and the first thing I wish to do is to thank Roger Kockelbergh for the staggering amount of work he has put into the section in his time as Chairman, and for his continued input in 2011.

I thought it wise to communicate clearly my goals for the section. I think the mandate is for change to the section and I will do my very best to deliver change that the membership can be excited about.

The section’s strength is its scope for delivering comprehensive national audit.

The guiding principle, I think, should be that we only do projects that have a high chance of defining urological practice in the UK and abroad; the projects we undertake should take advantage of our national scope. Those projects should be time-limited, with clearly defined start and finish dates; our work should be of sufficient quality to be presented at our meetings and our work should lead to significant, class-leading publications.

To this end, I produced a discussion paper which was debated at a specially convened meeting of the section’s newly elected committee on 17 January, and also in a meeting with the President and President-elect and the senior administrative team at BAUS. I have also had discussions with numerous urologists and have met with Sarah Fowler, to get her unique perspective on data collection and the section.

We have a plan:

• Discontinuing the BAUS Cancer Registry
• Review of complex operations databases
• Launch of disease-specific audits
• Section’s role in sponsoring trials
• A signature big project
• High quality meetings

1. Discontinue the BAUS cancer registry

This has been a fine effort but, after 12 years of data collection, there have been very few publications and it has not changed the way urology is practised in any noticeable way. A thirteenth year of collection of data is unlikely to change that. Sarah Fowler tells me that the data being submitted these days is of very variable quality e.g. only 50% of entries have a clinical T stage attached; only 30% a pathological T stage attached; and 33% of the data has been returned without a consultant number.

I think the last thing we should be doing as an organisation is spending time collecting data of dubious quality. In essence I think this project has run its course.

There are probably projects that could look at the 12 years of information already collected and these can continue to be encouraged on a project-by-project basis.

A number of centres have already submitted data for 2010 and all data submitted will be analysed with a report prepared as usual. The deadline for final submission of 2010 data to the BCR will be 1 March 2011, after which data collection to the BCR will cease.

The reason I think this is an important first step is that, if we are to secure the support of hard pressed urologists up and down the country for new projects, we must create room in urologists’ timetables by discontinuing time-consuming projects that are not currently generating significant results.

2. Promote very strongly the complex operations database

This seems the dataset that is of most relevance to improving the quality of urological surgery and needs to be the centre of our attention. Our aim should be to have data collection as comprehensive as the cardiothoracic national audits

I submitted no data in 2010, and I am embarrassed by that, but I think, in a curious way, that is a good place to start! The approach to this must be one of encouragement, not criticism, of individual members. The committee need to understand why urologists like Tim O’Brien were not engaged and submitting data. I think, in part, this was because of a perception that data collection within BAUS Oncology led nowhere, hence my desire to discontinue the BAUS Cancer Registry.

Each of the complex operation fields is being rapidly overhauled by teams from the section committee, in conjunction with Sarah Fowler, in order that they are fit for purpose in 2011. Where appropriate, fields that were previously included in the BCR minimum dataset will be included in the complex operations datasets. This process should be complete by early March 2011.

Jeremy Crew and Greg Boustead - cystectomy;
Tim O’Brien and Roger Kockelbergh - nephrectomy;
Declan Cahill, Alan McNeill, Simon Brewster & Vaikuntam Srinivasan - radical prostatectomy.

In 2011 we will develop fields for RPLND.

The proformas for each of the audits are available on the BAUS website at by clicking here. If members have specific suggestions about any of the audits, I suggest they contact one of the named urologists to air their views.

Each of the committee will take a role as champions in their own hospitals and networks and will be encouraging their friends and associates to enter data, if necessary by showing colleagues how to do it. Our approach will be to encourage, not coerce, and, in any event, we have no statutory power. Our aim is to increase, by 25% per year, the number of urologists who enter their data.

I have spoken to some of the key figures in the national cardiac surgical data project and an incremental collaborative approach was successful for them.

I should add that, since 1 January 2011, I have entered all my data. It has proved straightforward. Sarah Fowler can supply passwords. The audits can be accessed by clicking here.

I think the reason to collect this data is to obtain a far more meaningful perspective on the operations we do. The urological literature is flawed because of the bias that comes from the publication of results from a few well-renowned centres of excellence, often in the USA.

3. Disease-specific audits to take advantage of the national perspective of BAUS Oncology

It seems a key goal of BAUS Oncology should be to think as one national organisation. In essence, can we generate an ethos of ‘together we can achieve more than we can as fragmented small groups’? The ideal diseases, conditions and procedures to demonstrate this are, probably, the relatively unusual things for which only a national perspective can provide answers. This we did with the ODMIT-C trial of surgery for upper tract TCC back in 2001 which, incidentally, I am submitting for publication in February on behalf of the Section.

The advantage of taking relatively unusual conditions is that the burden for each team is relatively light (~ 10 cases a year) and therefore manageable. The aim would be for the publications that arise from these pieces of work to be the reference articles on the subject. ‘ Have you read the BAUS oncology audit of …..?’.

These projects must be time or number-limited, with a plan which is very clearly and relentlessly communicated to the membership. For example:

After discussion with the Section committee, we have elected to initiate a project of this type in 2011. This is to see if we have the will, the desire, and the organisational capability as a section to see this work completed. The study for 2011 will be “A national audit of surveillance of solid renal masses”.

We will be in touch with members with more details shortly but it is imagined this will commence in May 2011. If this audit is successful, I imagine this type of project will become one of the mainstays of what we do as a section.

Ideas from members for audits in 2012 are welcome, and I, or members of the committee, will be happy to discuss. Early candidates are a study of serious sepsis following prostate biopsy and an audit of radiofrequency ablation in renal cancer.

4. Currently we do not think the section should be sponsoring trials.

In the future, BAUS Oncology trials may be possible but, currently, the committee do not think the organisation is in a position to drive the establishment of trials. The NCRN disease groups are in a better position to do this; we should collaborate with them but not compete with them.

Although the Section did a magnificent job in recruiting for the ODMIT C trial, the research governance apparatus has changed so much since 2001 that running trials in the way ODMIT C was run is just no longer tenable.

At the moment we feel the Section should concern itself with the highest quality audit, not with trials.

5. A signature big project

The projects I have outlined in sections 2-3 above would produce results quickly. I think our organisation should also have a major ambitious goal which might be considered a ‘game changer’ in urological disease, and which takes advantage of our national perspective. Can BAUS Oncology bring never-before-seen scale to a project? Could we design a project that brings urologists together from all over the country to work with scientists to emphasise a national effort to deliver an important research goal?

I proposed to the committee that such a project might be a national project to “Identify a serum marker for renal cancer”.

BAUS Oncology could, potentially, bring scale to a project of this sort. 20 units doing 50 nephrectomies a year could collect the tissue and serum from 1000 cases in one year. This sort of project would be two years in the planning and, clearly, would need massive support but we might get it if we can bring the commitment of urologists up and down the country to bear. The attraction to a funding body is, of course, the pace with which we could collect the relevant material, thereby increasing the chances of success and keeping costs down.

The committee thought this an idea worth exploring which I will do in 2011 with interested parties.

6. High quality meetings

An important focal point of the Section is the Annual Meeting in the autumn and the BAUS Oncology sponsored sessions at the main BAUS Meeting in June. The new committee had vigorous discussions about the format and conduct of these meetings, in order to maximise their appeal to members. Roger Kockelbergh and Raj Persad have put together a very interesting programme for June 2011 and we plan to have a stimulating meeting centred on renal cancer on Monday 14 – Tuesday 15 November 2011 at the Royal College of Surgeons in London. Again, suggestions from members are very welcome. Details to follow.

I hope this newsletter clearly communicates "a direction of travel" for BAUS Oncology over the next two years. My aim is, simply, to re-focus the eyes of the Section, maximise the impact of the activities of the Section and to make the members of the Section pleased that they contributed to national projects that improved urological care.

Yours,

Tim O’Brien
1 February 2011