Author Archives: Caitriona Higgins

Advanced Endoscopic Techniques improve Patient Outcomes

My name is Professor Danny Cheriyan, and I’m a Consultant Gastroenterologist in Beaumont Hospital. I work in all areas of gastroenterology but I have a special interest in advanced endoscopy. One of the procedures that I’m particularly interested in is Endoscopic Submucosal Dissection (ESD).

ESD is a minimally invasive endoscopic procedure that is performed under general anaesthesia. I use a flexible tube called an endoscope to see and treat early cancers of the upper gastrointestinal tract (oesophagus and stomach). This procedure allows for a lesion to be removed in one piece, without the need for removing a large part of the oesophagus or stomach. This results in a much shorter procedure, shorter length of stay in hospital (typically 1 day), and a much easier recovery for the patient (compared to major surgery, which involves a 12 to 14 inpatient stay). Most importantly, patients have their natural anatomy intact after the procedure.

Beaumont Hospital is currently the only hospital in the country performing ESD. We began this procedure 2 years ago and have performed it successfully on over 30 patients. To further advance our skills and patient care, I will be undertaking a short sabbatical in Japan this year, to train further and gain more experience with this advanced technique.

 

Dr Daniel Ryan updates us on Innovative Endoscopic interventions for Lung Cancer Patients

The Lung Cancer Service offers swift access for patients with a suspicion of lung Cancer via the Rapid Access Lung Cancer Clinic and see 96% of referrals within 10 working days. However having swift access to diagnostics is just as important for our patients. The Beaumont Hospital Endoscopy Suite has 15 slots for Bronchoscopy and up to 8 for Endobronchial Ultrasound (EBUS) weekly, which means that our patients can have these diagnostic procedures done within 7 to 10 working days of booking them.

 

Dr Daniel Ryan, Respiratory Consultant in Beaumont RCSI Cancer Centre tells us a bit about some of the innovative endoscopic techniques used for diagnosis and treatment in Lung Cancer.

In 2023 a technique called Radial Probe EBUS was introduced. This now means that more peripheral lung lesions located beyond the reach of normal bronchoscopy or EBUS, can be sampled reducing the need for Percutaneous Biopsy.

Another procedure performed in the endoscopy unit, that benefits our cancer patients, are Indwelling Pleural Catheters (IPCs). Over 50% of patients with advanced lung cancer suffer the discomfort of pleural effusions. Management of this often requires prolonged inpatient stay.  With this procedure, we now insert indwelling pleural catheters as outpatients in the Endoscopy to alleviate symptoms, improve overall quality of life and allow patients to spend more time at home independently

We continually monitor and review the timelines from referral to diagnosis and treatment and the diagnostic and treatment interventions we carry to make sure we can provide the best service for our Lung Cancer patients.

Rozanna Hardie highlights the important role of the Laboratory in the Cancer Patient’s Journey

 

The laboratory in the Beaumont RCSI Cancer Centre is made up of many different departments, all of which at some point have a part to play in helping Cancer Patients through their journey from diagnosis, to treatment.

Rozanna Hardie, Business Manager in the Laboratory gives us an insight into how.

“Laboratories are made up of many different departments and look after blood, fluid and tissue samples. Here are some examples of where we are involved in with our Cancer patients.

Phlebotomy: All Cancer patients will meet our phlebotomy staff on a regular basis. Skilled phlebotomists minimise any discomfort to patients.

Sample Receipt: Medical Lab Aides perform all the pre-analytical preparation of blood, fluid and tissue samples so they are ready for analysis by our scientists.

Chemical Pathology: Here we can provide levels of certain tumour markers in a patient’s blood, we also provide results on various organ functions that indicate any side effects from treatment e.g. liver and renal function tests. Specialist testing can detect underlying cancers

Haematology: Clinicians are provided with details on a range of blood cells including platelets and haemoglobin which will indicate if a cancer patient requires a blood transfusion. Scientists here also perform specialised testing to diagnose blood cancers.

Blood transfusion: Scientists here ensure that the correct blood and blood products are dispensed for much need blood transfusions.

Immunology: Specialist antibody testing is provided by this department that can support treatment plans. Clinical Immunology are also responsible for providing Immunogloblin therapy.

Microbiology:  Infection is always a concern for cancer patients as many treatments leave them with weak immune systems. Microbiology staff play a vital role in checking patient samples for infection and where they find it making recommendations on treatments that will work on these infections.

Histopathology: This is where tissue samples are analysed. These are sent to diagnose a cancer or to find out the extent of a cancer after surgery and our Histopathologists attend all multi-disciplinary meetings with a patient’s entire team of clinicians.

Molecular pathology: Next generation sequencing is one of the more advanced techniques and is used to look at the DNA of the tumour sample. This is an essential part of supporting targeted treatment. This laboratory also provides a national service for neurological tumour molecular testing.

Patients are at the centre of everything we do, so ensuring excellent quality of procedures as well as making sure the highest standard of accurate results are available in a timely manner are important to all the staff here. Laboratory services see ever increasing numbers of samples arriving for analysis every year. Last year alone we provided clinical teams with over 20 million test results. We couldn’t do this without our team of Consultants, Scientists, Lab Aides and Administrators and support from the wider hospital. We are a fully accredited lab and continue to strive for excellence for all our patients (This means we meet all the safety and quality conditions that are required for a centre of excellence)”

 

The ADEPPT Clinical Trial opens in Beaumont Hospital

My name is Professor Jarushka Naidoo. I am a medical oncologist working in the Beaumont RCSI Cancer Centre and I am excited to announce that on November 9th we opened the ADEPPT trial in Beaumont Hospital. This trial, which is being run by ETOP-IBCSG clinical trials group, and locally by Cancer Trials Ireland focuses on providing access to novel targeted therapies for lung cancer, and to patients who are normally not included in clinical trials- to expand their reach.

Patients who are elderly with NSCLC (age over 70) or those who are unwell to start with (PS2) are often excluded from trials, but make up >40% of the population with lung cancer. KRAS G12C-mutant NSCLC is a specific type of lung cancer. Currently there are no approved targeted treatments for patients with this type of lung cancer.

The patients that will be invited to take part in this trial which involves treatment with Adagrasib are:

  1. Patients with KRASG12C-mutant NSCLC, including patients aged ≥18 years who have a poor functional status (ECOG PS=2) [Cohort 1]
    OR
  2. Elderly (≥70 years) (ECOG PS=0-1) Cohort 2

Opening and running studies like this would not be possible without the collective efforts of all members of the lung team, the molecular lab, and being part of a cancer centre that is reaching high in terms of advancing availability and access to Clinical Trials for patients.

For more information about the ADEPPT Trial Click Here

 

 

 

 

 

Breast Cancer – It’s not always a lump!

Jane is a patient of the breast cancer service in Beaumont RCSI Cancer Centre. Jane was diagnosed with breast cancer in 2022 and here she shares her story and important message:

“My name is Jane, I was diagnosed with breast cancer aged 46 and I’m telling you my story because I want you to know that you should see your GP if you notice any changes to your breast. Breast Cancer does not always mean finding a lump or detection by mammogram. I first noticed a small rash near my right nipple in September 2022. My GP thought it could be eczema, I’ve never had any skin complaints and when it didn’t improve she promptly referred me to the Breast Cancer Rapid Access Clinic in Beaumont Hospital.

When I first came to the clinic I met Professor Hill’s team, I was examined and quickly had a mammogram and ultrasound on that same day. Nothing showed up on these, given my age and the fact that I had no other symptoms and have no family history of breast cancer I felt very reassured. However, the importance of following up was impressed upon me. I was prescribed a steroid cream and given a follow-up appointment. Even though the rash improved it didn’t go away and so, after a further observation period, the team advised me to have a biopsy. This made me feel confident that all avenues were being fully investigated, I felt assured that I was ‘in the system’ and the team would soon have an explanation for the rash.

I was given the results of my biopsy in clinic and I was shocked to learn that my diagnosis was Paget’s Disease (which I had never heard of) with Breast Cancer (Invasive Ductal Carcinoma ER+, PR+, HER2+). At that same appointment I was given a clear plan for the initial treatment based on the histopathology report.  I learned about the MDT meetings and it was helpful for me to know that I was already scheduled for an MRI, which was followed by wire guided ultrasound and then a wide local excision of the area.

I recovered quickly from the Wide Local Excision and removal of sentinel nodes, which were clear of cancer, but the results of this and further MDT discussion helped me understand that there was a very small focus of invasive breast cancer in 3 parts of my breast which had proven difficult to locate by imagery and ultimately I decided with my team the best treatment for me was to proceed with a double mastectomy with immediate DIEP flap reconstruction which was scheduled within weeks. At all stages I felt hugely supported by the team in Beaumont in learning about my own diagnosis and was well informed about all decisions and options before and after my surgery and results. I was encouraged to ask questions. I took a lot of notes and benefitted from the MDT process and in-person consultations with familiar and very kind faces. I felt that a team of highly experienced and specialised experts contributed to my diagnosis and treatment plan.

My mastectomy and reconstruction in May was very successful. I have since undergone a course of Chemotherapy under Professor Patrick Morris and will continue with Herceptin treatment for a further period of time. With the support of my employer I am back to full time work.

I’m a survivor of breast Cancer. My message to others is to prioritise your own well-being and contact your GP if you notice any changes to your breast. It really is the most important form of self-care. I had no lump or other symptoms, no family history and would not be called to BreastCheck until 2026, yet I had breast cancer.

I have benefitted hugely from the knowledge and experience of Professor Hill’s team and will always be grateful to them and also to my husband Dan who encouraged me to see the GP initially and is always in my corner”

Breast Cancer Nursing Team

Anne Staunton, Breast Care Nurse: “I was Jane’s Breast Care Nurse, I am one of the six clinical Nurse Specialists in Breast Care and we meet our patients in the Triple Assessment clinics (TAC) and the review clinics.  My role was to be there for Jane at the time of her diagnosis and throughout her patient journey in Beaumont.  As with all my patients I provided Jane with my contact details so she could phone me directly with any questions about her diagnosis and treatment plan I could make sure she had all the information and support she needed”.

“All patients with cancer have their case discussed at a multidisciplinary meeting, these are held every week with Surgeons, Medical and Radiation Oncologists, Pathology and Radiology Consultants and the Nursing Team. Results of scans and pathology are discussed so that the best possible diagnostic or treatment options for patients can be made by the whole team. The results of these meetings were explained to Jane in clinic to help her make decisions about her treatment”

Beaumont RCSI Cancer Centre Breast Cancer Team

 

 

 

 

 

 

Meet the Nurse Specialists in Haematology

The Haematology Department in Beaumont looks after patients with blood cancers and other blood disorders. There is one Advanced Nurse Practitioner and five Clinical Nurse Specialists and we work with seven Haematology Consultants, their non consultant hospital doctors and a wide multidisciplinary team to support patients that come to our service either in St Teresa’s Haematology Inpatient Unit and the Coleman K. Byrne Haematology Day Unit.

St Teresa’s has fourteen individual isolation HEPA- filtered rooms and the Coleman K. Byrne Day unit has three consultation/procedure rooms and nine treatment chairs. We see and treat up to 45 patients every day and also have five outpatient clinics every week.

Throughout these areas, our team diagnose, manage, monitor and support haematology patients with a range of conditions by providing chemotherapy, immunotherapies, transplants and supportive treatments.

Particular areas of focus for Haematology CNS include:

  • Transplant (autologous and allogeneic)
  • Patient education regarding diagnosis and treatment
  • Linking patients with other members of the multidisciplinary team where this is needed e.g. social work, physiotherapy.
  • Support our patients throughout their diagnosis and treatment
  • Teaching other staff
  • Being a link for patients that need help and advice through the Telephone Triage service

A Bit About Us!

 

                  Aoife Mc Cormack                                                                     Frances Martin

We are Clinical Nurse Specialists and our role is to coordinate bone marrow transplants. The cell treatments that are available to our patients at present are autologous stem cell, allogeneic stem cell and CAR T cell therapies.

Autologous stem cell transplants are used as treatment in patients with multiple myeloma, amyloidosis and lymphoma. It is a process where once the patient’s condition is under control, we stimulate their bone marrow to produce stem cells and harvest them peripherally. The patient then receives these cells back as a form of rescue following high doses of chemotherapy with the aim of achieving a deeper/prolonged remission.

Allogenic stem cell transplants are used as treatment for various forms of leukaemia and lymphoma. This involves the patient receiving high doses of chemotherapy with or without radiation therapy to weaken their bone marrow, following that they receive stem cells which have been harvested from a matched donor. The aim is to replace the patient’s defective marrow with the donor cells to achieve remission.

Car T cell therapies are a relatively new form of treatment for the past 2 years in Ireland, where in the patients T cells are harvested, modified in a laboratory to make the patients cancer cell their new target, and then reinfused to the patient following chemotherapy. Currently it is available to particular lymphoma and leukaemia groups in Ireland but is being used to treat a variety of haematological conditions worldwide. We liaise with external referring hospitals, notably Our lady of Lourdes hospital, Connolly hospital and Blackrock Health at the Hermitage Clinic, to facilitate these treatments in conjunction with St James hospital stem cell transplantation service

 

Laura Mc Kiernan

I am a Clinical Nurse Specialist and I support and educate patients with a newly diagnosed or relapsed blood cancer. I meet patients after receiving their diagnosis and before they start treatment in the inpatient or outpatient setting. I help my patients to understand their medications, prepare them for treatment side effects and provide advice on symptom management.

I also make sure they are aware of all the support resources available here in the hospital and in the community, ensuring they are appropriately referred from the beginning of their  cancer journey.

Cancer information can be extremely overwhelming to take in, and it is difficult to retain all of the information during such an uncertain time. Therefore, it is so important that family members or loved ones are involved in the continual education and information process. I am learning a lot about what is important to patients on diagnosis. I am developing a patient experience survey in order to get feedback that I will use to improve my practice and to plan for the future of this service, ensuring the development of a sustainable patient focused service.

Marie Clare Mc Evoy

I am a Clinical Nurse Specialist and my role is to manage the Telephone Triage service which is for Haematology patients on active Systemic Anti-Cancer Therapy (SACT) and other haematology patients. I started in this role, which was set up in response to the COVID-19 pandemic to decrease hospital/ED attendance for our patients, in 2020. We have successfully introduced the UK Oncology Nurses Society (UKONS) telephone triage tool to grade symptoms and side effects of treatment, and direct the care of patients who are unwell at home. Advice is then given to patients on how to proceed. This may just be general advice and support or to go to their GP or local Emergency Department. All patients receive education regarding the importance of reporting disease symptoms and side effects of treatment to the contact numbers. The service is available 24/7 365 days a year. Out of hours is provided by St. Teresa’s haematology inpatient ward and CKB haematology day unit alongside the Haematology and Oncology medical on-call team. I follow up all calls the next working day either by phone or in person if the patient has been admitted.

Avril Furey

The main focus of my role as Haematology CNS is on early detection and survivorship in patients with haematological malignancies. Early detection of blood cancers leads to improved patient survival and access to services for diagnosis within Beaumont Hospital. This role will improve the patient journey from the community to cancer diagnosis, and facilitate the early detection of new cancers and relapsed cancers. It will also facilitate the development of a survivorship service to meet the increasing needs of patients who live longer on novel therapies. An important aspect of survivorship is effective patient education which lays the foundation for a better patient journey.

Rachel Fox

I have been in post as an Advanced Nurse Practitioner (ANP) in haematology since 2018, and provide a complete episode of care to patients’ with Myeloproliferative Neoplasms (MPN’s) and many other blood cancers attending CKB haematology day unit and the outpatient haematology service.  As an ANP I provide an outpatient service for patients’ with stable blood cancers to facilitate comprehensive review, assessment, diagnosis, investigation and treatment, as well as striving to meet social and psychological care needs. This service is delivered with the oversight of the Consultant Haematology team, considering international best practice guidelines and evidence based research applied to the patient review process, whilst providing a timely, safe and effective service. I work autonomously with medical and nursing teams, with focus on improving patient care and patient satisfaction, contributing to the continuous improvement of the quality of care experienced by patients and their families.

I believe promoting patient centered care, educating patients’ locally and nationally on disease specific issues, and linking with appropriate patient advocacy groups and community services, are core to effective chronic disease self-management for patients at home with haematological malignancy.

Be Sun Smart and Skin Cancer Aware

Ireland has one of the highest incidence of skin cancer and with 13,000 cases a year it is the most common cancer in Ireland.

Skin Cancer awareness for children and their parents is essential as they are likely to be outside for long periods of time, especially in warmer weather. Children’s skin is very sensitive to UV rays from the sun, and sunburn during childhood increases the risk of getting skin cancer as an adult. We used the HSE’s NCCP and Healthy Ireland Sun Smart picture that helps parents to pass on the “SLIP, SLOP, SLAP, SEEK, SLIDE” message to their children.

Although many people believe skin damage only happens when the sun is out UV rays are present all year round. UV rays intensity varies depending on time of year and are strongest typically from April to September between the hours of 11am to 3pm. You can check the UV index for the day by watching the weather forecast on television or online at the Irish Meteorological Service. Click Here

At Beaumont RCSI cancer Centre our aim is to promote the prevention and early detection of cancer through education and awareness events all year round.

May is skin cancer awareness month and our Skin Cancer Nursing Team have been busy raising awareness through a number of events on how to be SUN SMART.

Information stands in collaboration with the Irish Cancer Society and the Irish Skin Foundation engaged over 800 people in May. This essential work by dedicated specialists helps us to circulate the all-important message that “Prevention is better than Cure”. You can find out more about preventing skin cancer at:

The Irish Cancer Society Click Here

The Irish Skin Foundation Click Here

European Cancer Nursing Day 2023

Today is European Cancer Nursing Day and we are celebrating the fantastic contribution that nurses caring for our Cancer patients make in Beaumont RCSI Cancer Centre. This year’s theme is all about pioneering new approaches in cancer care through nursing innovation. Meet some of the cancer nurses involved in this in our Cancer Centre.

Emma Devoy Flood is a CNS in Head and Neck Cancer that is currently undertaking research with the RCSI to improve quality of life through the introduction of an e-support tool.

 

“Improving cancer nurse education improves cancer care.” Aine Byrne in the Centre of Education and Annmarie Elliot CPSN are involved in running level 9 post graduate oncology/haematology programmes with the RCSI, in addition to education programmes on Psycho-Oncology and SACT administration with the NCCP. Every year nurses are supported to attend ESO-EONS nursing masterclasses.

 

“Cancer Nurses have a key role in cancer prevention in Europe” The Cancer Centre has an annual calendar of cancer awareness and prevention events for staff, patients and the public.

Nurses throughout our cancer centre caring for patients with cancer are committed to delivering evidence-based personalised care that puts patients and their families at the heart of cancer care.