Summary

SummaryThe 2015 18th Annual BOPA symposium opened with pre-conference workshop sessions, followed by a welcome and introduction from Helen Flint, the BOPA Chair. Helen thanked everyone for their attendance, and encouraged the attendees to visit the poster sessions and get involved in discussion with others during the conference.

The conference, split over two and a half days, involved several clinical update sessions, debates and discussions around the Systemic Anti-Cancer Therapy (SACT) dataset and variations in funding across the UK, as well as some interesting updates on the genomics of lung cancer. The agenda also included several industry-sponsored satellites that provided updates on the latest treatments. To broaden the scope of the conference, Greg White, OBE, gave a motivational speech in the Succinct lecture on achieving the impossible. Mark Doyle also gave an introduction to the Method, a training program developed by actors to help professionals deliver top performance.

The BOPA Annual General Meeting was also held at this conference, and included an update on income, membership, and the annual work plan. As part of BOPAs continued commitment to education, two new e-learning modules on the history of chemotherapy and multiple myeloma are now available on the website; several webinars are also in development. The AGM report is also available on the BOPA website.

Pre-conference workshop session

Care of cancer patients in the community pharmacy

Chair – Susan Hull, Dispensary Manager, The Clatterbridge Cancer Centre

Susan Hull

Speakers – Jackie Lewis, Pharmacist Director, Lewis Pharmacy & Rowena Howell, Partnership Services Manager, Macmillan Cancer Support with representation from Boots and Lloyds.

This session highlighted that the practices of the community pharmacies are driven by patient experience and unmet needs, and that an important role for the pharmacies is to provide information and support services to patients who need them – a recent study showed that 25% of patients with cancer do not receive adequate support for their treatments or disease. Another aim of community pharmacies is to help patients self-manage their disease; however there are barriers to overcome.

Several challenges in community pharmacies were noted by the speakers, such as the lack of knowledge amongst the pharmacists about what services they can provide, and also patient-related factors such as what chemotherapies are being received. If pharmacists were aware of the co-medications patients were receiving they would better be able to assist with management of side effects and other issues. Despite the challenges faced by community pharmacists, patients value their role and see them as a bridge to the care services, and often provide them with information on side effects and treatment-associated issues that they did not tell their doctor.

Since there are approximately 500,000 patients suffering from poor health due to their cancer or associated treatments, there is a great potential benefit of increasing the role of community pharmacists in patient support and management.

Plenary session – should we use SACT to inform commissioning decisions?

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Chair – Calum Polwart, Lead Pharmacist for Cancer Services, County Durham & Darlington NHS Foundation Trust

Speakers – David Thomson, Chemotherapy Pharmacist Specialist Services (South Yorkshire & Bassetlaw), NHS England and National Cancer Drugs Fund Pharmacist & Professor David Dodwell, Consultant in Clinical Oncology, Leeds Cancer Centre/Institute of Oncology, St James’s University Hospital

The SACT database collects information such as NHS number, height, weight, chemotherapy regimen details, dosing and performance status from patients receiving treatment for cancer. David Thomson noted that prior to the SACT base, although data were being collected on cancer treatments, the level of detail was often lacking. For example, IMS data was used to track the total spending on biological agents post-NICE approval and noted an increase in their use, but beyond this the dataset was unable to provide information on the use of these treatments in different settings, e.g. homecare, clinical trials, and private clinics; and could not discriminate usage by indication. From 2009, initiatives were put in place to collect further data and to estimate and predict drug usage; despite accurate results there was still a lack of detail in this information on coverage, patient movement into different areas, and indication.

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Moving forward, the collection of data through the SACT database aims to save on costs while also improving services by comparing different treatment regimens in different areas and their impact on outcomes. It was speculated that in the future, SACT will be used in conjunction with the Cancer Drugs Funds (CDF) to evaluate drugs prior to NICE assessment; SACT will become an important monitoring tool to inform approval decisions and to provide real-life evaluation of some drugs.

David Dodwell continued the session by highlighting the differences between randomised controlled trials and real-world evidence generated from registries and other database. The former involve only selected patients, are often expensive, have pre-defined endpoints, and are usually fairly free of bias. The latter consist of ‘real’ patients, are cheaper to run, have limited endpoints, and are more open to bias. Real-world evidence, such as the data collected through the SACT database, is of particular use when it is employed in conjunction with data obtained from trials to determine whether a treatment effect from a clinical study translates in a real patient population. One example noted by David Dodwell was the discovery that radiotherapy increases the risk of lung cancer in smokers, even though in non-smokers and other patient groups it was reported to have a positive effect on survival. Since over 2 million drug records have been entered into the SACT database in just one year, there are many further analyses that can be performed to help inform commissioning and treatment decisions. To fully explore the potential benefit of the SACT database, an increase in the quality of outcomes data is needed, along with links to other databases and adequate resources. Most importantly, the success of the SACT database will rely on clinicians and commissioners being willing to devote the time needed to generate a high-quality and useful repository of information.

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Clinical updates – Chronic lymphocytic leukaemia

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Dr Jim Murray, Consultant Haematologist, University Hospitals Birmingham NHS Foundation Trust

Jim Murray presented a clinical perspective on chronic lymphocytic leukaemia (CLL), the most common haematological malignancy, which is generally associated with increasing age. While a diagnosis of leukaemia is often worrying to patients, low grade indolent CLL often does not require treatment.

The Binet system classifies CLL into stages A, B, and C; with C being the most serious, associated with poor survival times of just several months. Various chromosomal changes can now be detected through cytogenetics, which can inform average median survival; mutations such as the del(13q) classify a case of CLL as low risk, while the del(17p) mutation classifies a case as high-risk, with estimated survival under 2 years.

Further genetic changes such as the TP53 mutation are also associated with poor outcomes. Historical treatments such as chlorambucil and fludarabine have been improved through the addition of rituximab, leading to year-on-year increases in response rates. Of late, newer therapies such as ibrutinib and idelalisib have been recommended by the British Committee for Standards in Haematology (BCSH) for patients with the deleterious TP53 mutation. Cytogenetic analysis and the availability of newer oral therapies has significantly improved the outcomes of CLL patients in the UK.

 

Clinical updates – Venous thromboembolism

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Dr Will Lester, Consultant Haematologist, University Hospitals Birmingham NHS Foundation Trust

In his presentation, Will Lester summarised the clinical aspects of venous thromboembolism (VTE), a disease that can result in pulmonary embolism, in which clots in the venous valve cusps break off and cause obstruction in organs such as the lungs or brain.

Will Lester also noted that the incidence of VTE is high in hospital patients, including those suffering from cancer, due to the injury tumours cause to the endothelium and their effect on blood constitution and blood flow.

Treatment for VTE involves anticoagulation to prevent thrombus formation; specific therapies include heparin, warfarin, and direct oral anticoagulants (DOACs). A risk of these therapies is bleeding; the anticoagulation level must be balanced so as not to completely inhibit clot formation. Cancer-associated thrombosis is an issue that commonly occurs in clinics, but its management is often unclear; DOACs are not recommended in these patients due to lack of supporting data.

Until newer therapies are fully explored, low-molecular weight heparin is considered the gold standard for anticoagulation in cancer treatment.

 

 

Plenary session – Variation in funding across the four home nations from a pharmacist’s perspective

The aim of this session was to provide different perspectives of funding and access to treatments across the four home countries of the UK. Each speaker was able to share learnings with the BOPA members regarding the different systems they use and the varying roles that pharmacists play in each country. 

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Fiona MacLean, Lead Clinical Pharmacist, New Victoria Hospital, Glasgow

In 2015/2016, Scotland has a £12 billion health and wellbeing budget, which has to account for everything from wages, facilities, upkeep, and equipment to medicines. Prescriptions alone cost over £1 billion per annum. Scotland has been tasked with making 3% efficiency savings, which means that medicines expenditures need to be accurately predicted. The Scottish Medicines Consortium (SMC) reviews clinical and cost effectiveness, and pharmacists play an important role in this process. Fiona MacClean described the many ways in which pharmacists in Scotland are involved in horizon scanning, monthly expenditure reports, directorate-level reports, implantation of patient access schemes, and efficiency savings contributions; as well as ways to minimise costs. Horizon scanning involves the creation of detailed monographs for drugs that determine their impact on budgets and services year on year, while newer schemes such as Patient And Clinician Engagement (PACE) look at cost-effectiveness thresholds and make cases for the funding of drugs for end of life care. Pharmacists in Scotland therefore have key roles in the introduction of new medicines, service planning, and post-introduction monitoring.

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Fionnuala Green, Regional Lead Cancer Services Pharmacist, Northern Ireland

In her presentation, Fionnuala Green gave an overview of the health services in Northern Ireland. Compared to the other countries in the UK, Northern Ireland has a relatively small population – around 1.8 million people – and therefore has a health system with good communication between services. The Northern Ireland Department of Health, Social Services and Public Safety (DHSSPSNI) sets policy and legislation, and presides over the Health and Social Care Board, which commissions medicines, and the Public Health Agency, which provides medical expertise. The DHSSPSNI primarily uses NICE and SMC decisions regarding the approval of drugs by way of guidance, but has its own system in which NICE decisions are not automatically implemented. The DHSSPSNI however cannot approve drugs that are not NICE-approved. Individual funding requests (IFRs) are available on a per-patient basis in cases of rare diseases, non-funded indications, or drugs that are not normally commissioned. While there are several drawbacks to the Northern Irish system, such as the lack of a specialist fund for non-approved drugs, patients benefit from both NICE and SMC decisions regarding new therapies.

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Bethan Tranter, Chief Pharmacist, Velindre Cancer Centre, Cardiff

Bethan Tranter began her presentation by describing the differences between the Welsh and English NHS. Unlike Scotland and Northern Ireland, Wales has NICE, which is the primary source of health technology appraisals. In addition to NICE however, the All Wales Medicines Strategy Group (AWMSG) performs its own assessments, mainly for high cost drugs. In cases of conflicting decisions, the NICE ruling trumps that of AWMSG. Beth Tranter noted that there has been an increase in the number of appraisals recently, with a significant amount of these relating to cancer drugs. Despite this, Wales is often viewed as having poor access to drugs compared to the England, such that individual patient funding requests (IPFRs) are used inappropriately as a way for patients to receive treatment with non-approved therapies that are available via the CDF in England. To remedy this, a proposed ‘One Wales’ cohort funding system is under consideration which could provide interim funding for drugs; this system would also require that outcomes data were collected that could later be submitted for full appraisals. It was Bethan Tranter’s hope that such a system would be implemented in Wales so that additional drugs could be made available for patients.

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Jacky Turner, Macmillan Principal Oncology Pharmacist, Guy’s and St Thomas’ NHS Foundation Trust & Area Team Oncology Pharmacist, NHS England.

In the final presentation, Jacky Turner gave her summary of the English NHS and the role of pharmacists. All chemotherapy is funded by NHS England rather than by clinical commissioning groups (CCGs), as is the case with many other drugs. Chemotherapy costs approximately £1.6 billion per annum, which accounts for 12% of the total specialised budget. To inform commissioning decisions, NHS England receives advice from bodies such as the Chemotherapy Clinical Reference Group. Chemotherapy algorithms and the SACT database are planned to help decide on which drugs clinicians should prescribe and to monitor their use. Pharmacists within NHS England work across boundaries from provider to commissioner, and aid in the development of algorithms, procurement, the understanding of expenditures and e-prescribing. Trust Cancer pharmacists perform similar roles but also manage multidisciplinary team expectations by checking proposed therapies against the NICE list of drugs that are not indicated for treatments. Regarding the future of the NHS, Jacky Turner’s opinion was that drugs not approved by NICE could be given conditional approval in order to collect data to re-inform the process, and that pharmacists would need to play a key role in this system.

 

Plenary session – Genomic advances in lung cancer

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Chair – Stephen Kelly, Medical Affairs Manager, Pfizer Oncology UK & Helen Flint, BOPA Chair

To introduce this session, Stephen Kelly noted the unmet need that still exists for lung cancer, a disease that is the most common cause of cancer deaths. Steps are however being taken to improve patient outcomes, with the development of new targeted therapies in the past 5–10 years and an increasing number of molecular tests to identify such targets.

 

John Gosney, Consultant Thoracic Pathologist, Royal Liverpool University Hospital

2015 Meeting ReportAs a pathologist, John Gosney began by highlighting the increasing detail that must be included in pathology reports from tumours now that genetic and molecular testing is commonplace. Historical pathology reports generally only included detail on tumour type, for example whether a tumour was a squamous oradenocarcinoma, whereas now a full raft of detailed test results are needed due to the strict requirements of the newer targeted therapies. A pathologist now has to assess tumour subtypes through morphology and immunohistochemistry, test for mutations in genes such as KRAS and EGFR and translocations in ALK, and also assess immunomodulation via markers such as PD-1 and PD-L1.

The latter assessments are needed for treatment with cancer immunotherapies, which are newer drugs that target dysregulated immune checkpoint proteins that enable the tumour cells to evade the immune system. With all pathology testing, an important point raised by John Gosney was that sample quality is critical – with the number of tests for tumours likely to increase, accurate assessments will be needed to ensure that patients are given appropriate treatments.

 

Clive Mulatero, Clinical Lead for Molecular Oncology & Consultant in Medical Oncology, Leeds Teaching Hospitals NHS Trust

2015 Meeting ReportClive Mulatero began by reiterating the current unmet need in lung cancer, a disease in which 10% of patients have a 5 year median survival. There are now several ‘druggable’ targets in lung cancer, a particularly noteworthy example being the EGFR gene; the targeted agents afatinib, erlotinib and gefitinib have all shown positive efficacy results for patients with EGFR mutations. Despite their efficacy benefits, newer targeted therapies eventually stop working; a main reason for this is the evolution of resistance mechanisms by the cancer. In total, 60% of cases of resistance to EGFR therapies are due to a single point mutation in the target protein, which affects protein shape and thus the ability of the drug to bind and exert its effect.

The T790M mutation renders these targeted therapies inactive, but there are newer drugs in development such as AZD9291 that take into account this protein shape change and have shown favourable results in standard EGFR therapy-resistant patients. Beyond this, cancers have been shown to develop resistance to these therapies, but there are mutations that are sensitive to other drugs based on types of protein folding. In summary, treatment changes tumour biology, which is why genomic testing is particularly important; through the identification of specific mutations, patients can be give effective and targeted treatments.

 

Clinical update – High-grade lymphomas

2015 Meeting ReportDr Morag Griffin, Locum Consultant, Leeds Teaching Hospital NHS Trust

In her presentation, Morag Griffin gave an overview of high grade lymphomas, including new molecules available for these diseases. High grade lymphoma subtypes include acute lymphoblastic leukaemia; B cell lymphomas such as Burkitt lymphoma, diffuse large B cell lymphoma (DLBCL), and mantle cell lymphoma; and T cell lymphomas such as anaplastic large cell lymphoma. Burkitt lymphoma presents at a younger age than other lymphoma types, around 30 years of age, while others generally occur in the sixth decade of life.

While there are few clinical trials currently recruiting for Burkitt lymphoma, there are several new molecules in development or recently made available for DLBCL, such as ibrutinib, idelalisib, obinutuzumab, and various histone methyltransferase and kinase inhibitors. T cell lymphomas are typically treated with CHOP chemotherapy followed by consolidation with bone marrow transplant; there are frontline trials examining agents such as brentuximab and relapse trials of lenalidomide, the folate antagonist pralatrexate, JAK2 inhibitors, and the histone deacetylase inhibitors romidepsin, belinostat and panobinostat.

 

Plenary session – Poster discussion session

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Chair – Carl Booth, Lead Pharmacist, Cancer Services & Clinical Trials, Airedale NHS Foundation Trust

This session provided an opportunity for the presenters of the five best posters at the conference to discuss their results. The Chair noted that a survey of BOPA members found that although many carry out their own clinical auditing, a lack of support and resources prevent others from doing so. It is an aim of BOPA to provide assistance with carrying out and publishing clinical audits.

 

 

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Sam Malton, Advanced Pharmacy Practitioner Oncology and Cancer Pharmacy Team Leader, Nottingham University Hospitals

Sam Malton presented his study on the impact of an advanced pharmacy practitioner (APP) role in oncology, first by noting that busy clinics during a period of workforce change and restructuring provided the opportunity for an APP to set up a specialised service in his hospital. Using the example of separate prostate and breast clinics, Sam Malton described a system whereby pharmacists would perform reviews and telephone contacts after initial consultant review. This system saved £28,458 over the course of a year for commissioners, and had positive feedback from both patients and clinicians.

 

 

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Jennifer Laskey, Beatson West of Scotland Cancer Care, Glasgow

Jennifer Laskey presented the results of a Medicines Use Evaluation in the West of Scotland (WOS), auditing the off-label post-pazopanib use of axitinib in renal cell carcinoma (RCC) according to local policy. It was found that compared to the AXIS trial of axitinib, patients in the WOS were in higher-risk subgroups and had brain metastases. The recommended dose of 5 mg was also used as in the trial. Median duration of treatment was 147 days, which was also comparable to AXIS. This study was useful as it demonstrated the compliance of WOS with policy and provided accurate information on treatment uptake.

 

 

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Andrea Preston, Divisional Lead Pharmacist, Haematology and Oncology, University Hospitals Bristol NHS Foundation Trust

This study examined the dosing of chemotherapy in obese adult patients with cancer, from a UK perspective. In 2012, the American Society of Clinical Oncology (ASCO) published guidance stating that chemotherapy doses should be adjusted by bodyweight without an upper limit, rather than being capped. The objective of Andrea Preston’s study was to determine current practice in the UK regarding bodyweight chemotherapy adjustment. The 81 responders were split as to whether they capped doses, with 53% responding affirmatively. The formula used for dose adjustment also varied, and there was 50/50 split as to whether the ASCO guidelines had changed their practice. Andrea Preston concluded that further evidence and research is required into this area and that dosing information should be properly communicated to healthcare professionals.

 

 

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Fiona MacLean, Lead Clinical Pharmacist, NHS Greater Glasgow and Clyde

Fiona MacLean gave an overview of the design and evaluation of a smartphone app for patients with cancer called the Wellness Tracker. Since e-health solutions are becoming increasingly essential to communicate between care settings and patients, an app was developed in collaboration with the University of Strathclyde. The app aimed to view and record medicines, toxicity and side effects, and appointments and clinical visits for patients receiving SACT. Patient interviews were conducted to determine requirements and the app was tested with multiple groups; it received an overall score of 92% from the patients. A separate patient questionnaire showed that 39% would use a smartphone app. Fiona MacClean concluded that patients need choice when it comes to paper vs electronic records, and that an app meets the needs of some patients.

 

 

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Colin Ward, Lead Pharmacist for Cancer, Derby Teaching Hospital NHS Foundation Trust

Colin Ward described an audit of pemetrexed maintenance post-pemetrexed/carboplatin doublet induction via the SACT database; evidence supporting this indication has not yet been established and is therefore not approved, although it is acknowledged as being used in some scenarios in clinical practice. Records of patients receiving this therapy were extracted from the SACT database and assessed against the audit standard of pemetrexed maintenance post-pemetrexed/cisplatin. It was found that of 844 patients, 81% met the audit standard, meaning that 19% were using the non-approved pemetrexed maintenance post-pemetrexed/carboplatin induction. The number of doses per year was identified, which came to a total cost of £682,000 from 2013–2015. These analyses show the limitations of relying on prior funding approval systems, and reinforce the need for local scrutiny of prescribing, and that the SACT database can be used to identify treatment patterns and pathways.

 

Clinical updates – Renal cell cancer

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Dr Guy Faust, Consultant Medical Oncologist, University Hospital of Leicester NHS Trust

In this clinical update session, Guy Faust spoke about renal cell carcinoma (RCC), its treatments, and potential future advances. He first noted that although RCC is rare, with 10,144 cases diagnosed in the UK in 2011, 30% of patients are metastatic at diagnosis and 30% have disease recurrence. Various risk factors can lead to poor outcomes; recent guidelines recommend the measurement of haemoglobin, calcium and white blood cells levels to assess prognosis. Resection is the most strongly preferred first-line treatment, after which immunotherapies such as interferon and interleukin-2, and targeted therapies such as sunitinib, pazopanib and temsirolimus have all shown increases in survival.

Axitinib and everolimus were highlighted as potential second line therapies. Newer promising treatments include the immuno-oncology therapies that have gained a great deal of attention in other cancers; for example, nivolumab has shown overall survival benefits in patients who received no more than three lines of therapy. The small molecule tyrosine kinase inhibitor cabozanitinib has also shown strong progression-free survival benefits vs everolimus.

Guy Faust was of the opinion that the treatment landscape for RCC is expanding in a stepwise manner, and that in the future we will have many more options available for patients.

 

 

Clinical updates – Drug interactions

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Mark Evans, Associate Chief Pharmacist, The Royal Marsden NHS Foundation Trust

The topic of Mark Evans’ presentation was drug interactions in cancer, which he viewed as an increasingly important topic due to the ever expanding number of drugs that cancer patients are given, whether it is to manage the disease or treatment-associated toxicities. A survey of the audience revealed that the majority did not feel that drug interactions are currently well managed, which showed the need for further work in this area. To remedy this, Mark Evans was of the opinion that e-prescribing tools should incorporate co-morbidities and co-medications and also provide some measure of decision support, so that during increasingly complex treatment schedules prescribers are able to manage the side effects and interactions of the multiple drugs they give.

Examples of newer drugs that require careful management are tyrosine kinase inhibitors (TKIs); these therapies can lose efficacy if stomach pH drops too low, which presents a challenge for prescribing proton pump inhibitors (PPIs) for nausea and vomiting. Suggested strategies in such cases include staggering doses so that the TKI and PPI are not given in a short period of time, lowering the dose, or choosing a PPI that has less of an interaction. Domperidone, which is commonly used to manage nausea and vomiting, was highlighted as a drug that poses a particular challenge as it can increase the risk of QT prolongation. Mark Evans concluded that the role of the pharmacist should be to advise on the most appropriate management of a potential interaction, taking into account the individual patient circumstances.

 

Plenary session – The Succinct Lecture – Achieve the impossible

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Dr Greg Whyte, OBE

To close the second day of the meeting, Greg Whyte, a noted Olympian and charity fundraiser, gave a speech on achieving the impossible. He has coached 19 Comic and Sport Relief challenges, including Eddie Izzard’s 43 marathons in 51 days, and David Walliams’ English Channel swim. He used examples such as these to summarise the determinants of success, noting that even for elite athletes it is not easy to do well. Belief, commitment and motivation were highlighted as important for success, and that a central motivator is needed in order to keep going with difficult tasks. The road to success needs a detailed plan and also preparation in order to achieve optimal performance. Finally, a good team is essential. Greg Whyte’s challenge for BOPA members was to extrapolate some of the learnings from the field of athletics and sport and translate them into their own practice so that they can engage with patients and perform their roles in a motivated and successful way.

Introduction to day 3

Plenary session – Maximise your personal impact

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Mark Doyle, The Method

To open the third and final day of the conference, Mark Doyle gave an introduction to the Method, a training program designed to help professionals deliver top performance. This system was developed by actors, under the principle that best practice behaviours in different situations can be used to improve outcomes and relationships at work. There are three stages to the Method:

Define: What is the gap between current and ideal behavioural practices? When surveyed, BOPA members stated that they wanted to be more confident, assertive, influential and trusted in both one-to-one meetings with consultants and when presenting to groups in an MDT setting

Transform: What observable behaviour changes can be adopted in these scenarios? Body language such as standing tall and making strong gestures are signs of confidence; it was also recommended to make eye contact, speak clearly, vary tone of voice and smile

Deliver: Commit to a live performance. This final step involves rehearsal and planning in advance so that the live ‘performance’ looks and feels natural. Adopting unfamiliar behaviours can be uncomfortable for many people, which is why commitment and practice is needed

Mark Doyle summarised by noting two important points. Firstly, people instantly see and judge behaviour; if they see a colleague acting in a confident manner they will assume that person is confident. Secondly, people become their behaviours; over time, adopting best practice behaviours will improve overall confidence in the workplace.

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Clinical update – Skin toxicities and melanoma

Professor Ruth Plummer, Consultant Medical Oncologist, Northern Centre for Cancer Care

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At the beginning of her presentation, Ruth Plummer pointed out that the incidence of melanoma is rising, and is the second most common cancer in young adults. With 2000 deaths per year in the UK, average melanoma survival is on average 6–9 months, and until 2011 there were no therapeutic agents that gave a survival benefit. In recent years, several therapies have emerged that have somewhat mitigated the otherwise poor survival of melanoma.

Targeted therapies such as dabrafenib and vemurafenib have been developed that are characterised by rapid response but also rapid resistance, while the immuno-oncology therapies such as nivolumab and ipilimumab result in a slower response but have the potential for longer duration of response. New therapies however come with new toxicities; the targeted therapies are associated with adverse events of the skin, with vemurafenib causing serious photosensitivity that can lead to significant sunburn. Other adverse effects include the development of squamous cell carcinomas.

To manage these toxicities, strategies include temporarily ceasing treatment and prescribing emollient, to lowering the dose. Secondary malignancies are often treated surgically. The toxicities associated with immuno-oncology treatments differ to targeted therapies, and can potentially be very serious. Ruth Plummer noted that autoimmune toxicities such as colitis are of particular concern, and there is a need for the development of treatment algorithms to ensure that patients in oncology clinics are effectively managed and that other specialists are involved. She concluded that the long-term data on these treatments should prove interesting, and that the pharmacist input into skin cancer clinics is hugely valuable.

Clinical update – What’s new in systemic therapy for head and neck cancer?

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Professor Kevin Harrington, Consultant Clinical Oncologist, The Royal Marsden NHS Foundation Trust

In order to describe new advances in head and neck cancer, Kevin Harrington first described historical and current treatments for this disease; platinum-based chemotherapy during radiotherapy had been shown to be superior to induction or adjuvant chemotherapy in terms of survival and was considered the gold standard. Studies examining the addition of cetuximab and panitumumab on top of chemo-radiotherapy unfortunately showed no additional benefit.

It was Kevin Harrington’s opinion that future treatments will likely use the concept of ‘synthetic lethality’; 83% of cancers delete the p53 DNA repair pathway and thus rely on an alternative pathway in order to fix errors – drugs targeting this second pathway provide a way to specifically kill tumour cells. Several drugs are currently in pre-clinical and clinical development, including a CHK1 inhibitor that has shown promising activity in mice.

There is a large interest amongst head and neck cancer specialists in immuno-oncology therapies; trials aiming for curative treatment in combination with chemo-radiotherapy are planned.

Summary of key themes, challenges, and close

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Helen Flint, BOPA Chair

To close the meeting, Helen Flint first thanked the BOPA members for attending and also the committee and Succinct for organising the event. She also thanked the many people who submitted and presented posters, noting their high quality and popularity during the conference. The prize for best poster was awarded to Mina Mansor for her study on a helpline for managing chemotherapy toxicities.

The prize for best presentation was award to Sam Malton for his work on the impact of an advanced pharmacy practitioner role in oncology clinics; Sam was given £2000 to attend an international conference, and the opportunity to present his learnings at BOPA 2016. Looking forward, Helen hoped that for next year’s meeting, 100 abstracts would be submitted and that BOPA would have 1000 members.

BOPA Vox Pop – Hear what the delegates say

How important are the networking opportunities?

How many times have you visited BOPA and why?


How important is BOPA to you personally?


Are the clinical update sessions important?

Date for diary: The 19th Annual BOPA Symposium

The 19th Annual BOPA Symposium will take place from 14–16 October 2016 in Manchester.