Minutes Bristol Testicular Cancer Service AGM – 9th July 2010 ...

prolonged stay in hospital. Whilst the patient required morphine for pain relief for his metastatic disease,he then required intensive pain management to change his wound dressings. AH commented that thesecases are rare and some teams find decision making hard, especially when the onus is on histology formost cancers.Recommendation: The team advised that all patients who fall into the Intermediate or Poor Prognosisstage of disease, or those with systemic symptoms, should be discussed with the Testicular Cancerconsultants prior to primary surgery. To be added to the referral guidelines and clinical guidelines.2. Patient 2: (Referral from Weston General Hospital): Admitted to WGH as an emergency with left sidedgroin and abdominal pain and raised HCG & LDH. Remained there for 3 days and then reviewed byurologist; discharged to have orchidectomy 6 days later. Dr Hillman discussed his case with Dr SusannaAlexander; he was admitted to ward 61 as an emergency and chemotherapy started immediately.Recommendation: The team advises primary referral centres that if they suspect a germ cell cancer andthe patient has pain and other symptoms to discuss with the Testicular Cancer consultants immediately.3. Patient 3: (Referral from Royal United Hospital): See attached slides.There was a very long discussion around the issues of drug toxicity, CT scans and symptoms, the MDTdiscussions relating to the dry cough and subsequent ADR. SA raised the issue of O2 therapy andbleomycin toxicity and JPB talked about the risks during anaesthetic. SB relayed to the team that the familywere not angry and fully understood that participating in the CT was patient choice and wanted us to knowthey were happy with his care and wanted to thank us for our care.Recommendation: The recommendation from RM was to consider earlier referral to their services;however SB stated how difficult this can be when the treatment aim remains radical/curative, but wouldhave benefited from the support from another team. SB has also spoken with the GP and with thepatient’s mother to arrange a mediated discussion with the initial GP as they still quite angry about hisdiagnosis and delays in referral.4. Patient NC (referral Royal United Hospital Bath): See attached slides.No problems to date with NC. SB said she has spoken with him at length he is coping psychologically verywell.Part TwoSpeaker Subject Discussion Action PointsDr Jeremy Braybrooke Introduction, agenda for theafternoon and what we doCathy Chesham MDT attendance and cancellationsReview of Current Clinical GuidelinesDr Susanna Alexander TIP Protocol (see slides) SB: thought that patients did cope well with the Action SB & SAtoxicity of the regimen better that BEP & EP andmost agreed.