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The Gathering Around Cancer 2018 conference will take place in Croke Park Convention Centre, Dublin, on Thursday 8 and Friday 9 November. The conference is one of the major oncology events of the year and will feature presentations from a wide panel of experts, who will give their perspective on the major developments within their specialty.
The inaugural meeting took place in 2013 to coincide with the Gathering events being held that year to mobilise the Irish diaspora. Since then, the event has gone from strength-to-strength.
“We had a very large meeting, a three-day meeting, at that time,” according to organiser and Consultant Medical Oncologist in the Mater Misericordiae University Hospital, Dublin, Prof John McCaffrey, who co-founded the event with Consultant Medical Oncologist in St James’s Hospital, Dublin, Prof David Gallagher.
“And it was so successful that we decided to carry on. It became a meeting that wasn’t disease-specific, but covered everything. It is mainly medical oncology but we take in radiation and surgery and paramedical also, so I think it satisfies all the things we needed and has become the meeting that people want to have.”
Speaking to the Medical Independent (MI) ahead of the 2018 meeting, Prof McCaffrey said he is delighted by the positive response the meeting has generated among the oncology community.
“Myself and David Gallagher continually get very positive feedback that people like the way we do it. We want stay fresh, so we try to change things a little bit each year,” according to Prof McCaffrey.
“But I think the formula we have now suits people.”
After the welcome address on Thursday, the first session of the conference will be devoted to presentations from ‘Young Investigators’. The topics in this session will range from immunotherapy in breast cancer to overcoming EGFR TKI’s resistance in lung cancer. Prof McCaffrey said that this is always one of the most popular sessions.
“A lot of these people will be known to the community in Ireland, and then to see the step up that people take when they go abroad is quite impressive,” Prof McCaffrey stated.
“And these are the people who will be our future leaders, so it is great to see it happening.”
The following session will be on the subject of ‘Global Oncology’. CEO of the Irish Cancer Society (ICS) Ms Averil Power will begin the session with a talk on patient advocacy. The next speaker, Dr Patricia Scanlon, Muhimbili University, Dar Es Salaam, Tanzania, will deliver a talk on the challenges of running an oncology programme in the developing world. Other talks concern ‘The Future of AYA Oncology’ and ‘Burnout in Oncology: A Global View’, which will be delivered by Dr Scheryll Alken, St James’s Hospital and Our Lady’s Children’s Hospital Crumlin and Dr Blanaid Hayes, Dean of the Faculty of Occupational Medicine, RCPI, respectively.
Prof McCaffrey told MI that meeting organisers felt that it was essential to cover the theme of burnout, given the enormous workload pressures those working in the field of oncology face.
“The inability of male and female doctors to disconnect from work isn’t something we pay a great deal of attention to,” according to Prof McCaffrey.
“Our only fear is that we are not giving it enough time on the programme. It is a huge issue and a topic that needs to get more air-time than is currently the case.”
Dr Sean Ennis from Genomics Medicine Ireland will give the last talk of the session on population genetics, industry and academic collaboration.
The final session of the day will be on the timely and controversial subject of cancer screening.
Head of Services and Advocacy at the ICS Mr Donal Buggy will talk about screening from the patient’s perspective. There will also be a presentation specifically on cervical cancer screening, which will be delivered by Prof Grainne Flannelly, St Vincent’s University Hospital, Dublin. Given the recent controversy concerning CervicalCheck and the publication of the Scally Report, these talks are sure to be of extreme interest to delegates.
Two of the presentations will be on the subject of breast cancer screening. Prof Fidelma Flanagan, Mater Hospital, will deliver the first talk, while Prof John Crown, St Vincent’s University Hospital, Dublin, will talk about the “benefits and pitfalls” of breast cancer screening. Colon screening will also be covered by Prof Diarmuid O’Donoghue, St Vincent’s University Hospital.
“I think it is to reaffirm the importance of screening in the various areas; to take a look at what has been achieved, to hopefully show that we are saving lives,” according to Prof McCaffrey.
“If we are doing something not right, that will come up at the meeting, and what are the steps that can be taken to reassure us as the practitioners and the wider public that there are clear benefits to doing it [screening].”
The first session on Friday will concern ‘Updates in Medical Oncology’. Prof Donal Brennan, University College Dublin, will start the session with a talk on gynaecology cancer surgery. This will be followed by a talk on ovarian cancer by Dr Dearbhaile O’Donnell, St James’s Hospital. Other subjects to be covered in the session include: Cervical/endometrium cancer; radiation therapy gynaecology; renal cell carcinoma; the central nervous system; and lung cancer.
GI, breast and prostate cancer
The next session will discuss aspects of GI cancer specifically. Presentations will cover upper GI cancer and lower GI cancer. Dr Steven Hochwald, Roswell Park Cancer Centre, New York, US, will speak about ‘Advances in Surgery for Gastro-oesophageal Malignancy’ in an eagerly-anticipated talk.
Dr Hochwald’s research focuses on technical advances in minimally-invasive oesophageal and GI surgeries and developing new targets and agents for treatment of pancreatic and other GI cancers. He has lectured both nationally and internationally on Western approaches to minimally-invasive oesophageal and gastric resection for malignancy and has published broadly on these topics. He has taught several courses and organised symposiums on minimally-invasive oesophagectomy. He serves as Editor of the book titled Minimally Invasive Foregut Surgery for Malignancy, which was published by Springer in 2015.
Prof John Reynolds, St James’s Hospital, will also give a presentation on the interesting topic of the relationship between obesity and cancer, while Prof Frank Sullivan, NUI Galway, will talk about diet and weight loss in cancer.
The final session of the conference is on both prostate and breast cancer. Subjects under discussion will include prostate surgery, radiation therapy, and systemic therapy. Prof David Gallagher will deliver a presentation on the role of the BRCA gene in prostate and breast cancer. Genetics will also be the subject of talks by Dr Janice Walshe, St Vincent’s University Hospital, who will discuss ER + HER2- stage IV breast cancer and Dr Cathy Kelly, Mater Hospital, who will talk about HER 2+. Dr Con Murphy, Bon Secours Hospital, Cork, will also deliver a presentation on triple-negative breast cancer.
The event comes just over a year since the National Cancer Strategy 2017-2026 was published. Prof McCaffrey believes that implementation of the strategy over the past 12 months has been “steady”.
“I think we are all encouraged by the need to improve manpower, especially in medical oncology centres, but also supportive staff, including dietetics and psycho-oncology and the nurse specialty. I think they are all important things. A 10-year plan always needs to be given time to work. Now in its third iteration, I think we have made huge progress in the time since we have had the strategies. Of course, you don’t get to where you need to be every time, but that’s the nature of the evolving landscape. Things like genetics and genomics need to be incorporated into the management of cancer also. Overall, I think on-the-ground resourcing is the most important thing to achieve in terms of implementation.”
Cancer Trials Ireland’s Autumn Scientific Meeting coincides with Gathering Around Cancer
Cancer Trials Ireland (CTI) will be holding its Autumn Scientific meeting on 8 November in the Croke Park Conference Centre to coincide with this year’s Gathering Around Cancer.
Registration begins at 8am and will conclude at 1pm. Registration for the Gathering Around Cancer starts at noon that day in the same venue.
CTI’s meeting will bring together members — medical, surgical, radiation oncologists, haematologists and research specialists (oncology research nurses, translational scientists and staff in cancer trials research units around the country) — to discuss the organisation’s 100+ cancer trials portfolio.
Separate meetings will be held during the morning in a range of disease-specific subgroups, giving participants the opportunity to share their experience and insights.
These meetings are only open to registered CTI members and will focus on the following disease types: Breast; gastrointestinal; genitourinary; gynaecology; lung; melanoma; and central nervous system.
The meeting will also include training modules for chief and co-chief investigators, new investigators and researcher training, and good clinical practice training.
Consultant Medical Oncologist in the Mater Misericordiae University Hospital Dublin Prof John McCaffrey told the Medical Independent that having the CTI meeting coincide with the Gathering makes sense, given the essential role of research within the oncology landscape.
“I think the fact that the Cancer Trials Ireland group are having a session ahead of ours is to capture the audience who go to the Gathering,” according to Prof McCaffrey.
“There is good synergy between the speakers who present and who attend the meeting and those who are conducting very important research for Cancer Trials Ireland and a lot of what will be presented will be multi-centre research done with bigger centres with Irish researchers being closely involved. So it is a very important partnership.”
There is no charge to attend and to register, contact email@example.com.
In 5-6 October in the Convention Centre Dublin a dedicated two-day meeting hosted by BMS/Pfizer on stroke prevention in non-valvular atrial fibrillation (NVAF) and the prevention and treatment of venous thromboembolism (VTE) will take place. The event will feature presentations from leading multidisciplinary international experts from Europe and Canada, as well as local expert Dr Rónán Collins, about the latest clinical advances in anticoagulation and practical guidance on how to apply this knowledge in patient practice.
In an interview with the Medical Independent (MI), Dr Collins stressed the need to increase awareness of atrial fibrillation, and its connection to stroke among both clinicians and the general public and the best ways to clinically manage it.
Dr Ronan Collins
“Atrial fibrillation is the commonest cardiac arrhythmia and affects about 5 per cent of people over the age of 60, and about 10 per cent of people over the age of 75, so therefore it is a very common condition and it is a growing problem because of our demography in Western Europe and also particularly in Ireland. Because of the huge risk factor for stroke, particularly in Ireland where about 35 per cent, a bit over one-in-three, strokes are caused by atrial fibrillation, it is crucially important in any stroke strategy that we pay attention to prevention.”
Dr Collins was involved in the development of the newly revised European Heart Rhythm Association (a branch of the European Society of Cardiology (ESC)) Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation (2018).
This Practical Guide, like its predecessors from 2013 and 2015, supplements ESC guidelines on how to use non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) in specific clinical situations for stroke prevention in patients with atrial fibrillation (available at www.NOACforAF.eu).
“We extended it this year beyond the traditional remit of just atrial fibrillation in general to consider special populations with atrial fibrillation, for example, those who are frail and quite old who may be quite prone to falling, they may have co-existent dementia, have age-related kidney issues, have lower body weight, etc. So for those reasons it was important that the document focused on special populations this year. It is within that context, as one of the authors of the guidelines that I will be speaking at this week’s meeting about optimising treatment management, with particular reference to older people, frail people, people who have just had a stroke and the importance of multidisciplinary working as well,” he explained.
Dr Collins stressed that a multidisciplinary approach to atrial fibrillation “is a critical point” that has been “an ESC recommendation for the last two years”.
“We are probably one of the few places in Europe that have an interdisciplinary atrial fibrillation clinic. In Tallaght Hospital our atrial fibrillation clinic is a joint effort between cardiology, geriatric and stroke medicine, clinical nurse specialists and pharmacy. We think that is the right way forward to deal with atrial fibrillation.”
Awareness of atrial fibrillation among the general population is poor in Ireland. Dr Collins noted the Irish Heart Foundation has run campaigns to try to address this but awareness still remains quite low; according to the most recent data less than 30 per cent of surveyed people in Ireland had heard of the condition. “Which is amazing as it is so common. The awareness is slightly higher in older people, which is good as older people are more likely to have it and it is slightly higher in higher socio-economic groups,” he said.
In addition, in people who have heard of atrial fibrillation most do not realise the connection with stroke, which is quite worrying, Dr Collins commented.
“Public awareness is low and we know it is even low in people who have atrial fibrillation; we know from a paper from Birmingham on people attending an atrial fibrillation clinic that less than half of them knew what it is. So if that was in a specialist clinic you can imagine what it [awareness] is like among the general public. Basically we know that only 25 per cent of people know anything about atrial fibrillation and only half of those are aware it is associated with a risk of stroke. So there is a lot to be done. I don’t think Ireland is very different from other European countries. There is a taskforce to get European Parliament engagement on this as a public health issue but we have a lot to do.”
In relation to anticoagulation of those who are at risk of stroke, Dr Collins said that while more people are being treated, there is still much unmet need. He noted that the use of NOACs has increased dramatically in the last five years in Ireland and that it is now well-established that warfarin is no longer the gold standard of care with the newer NOACs being the first choice for anticoagulation as per the ESC guidelines.
“To be fair I think we are doing much better in this regard. If you look at the pharmacoeconomic data there has been a huge increase in the use of NOACs. Therefore, there are a lot more prescriptions being written… Clearly these drugs cost and I’m not saying pharmacoeconomics aren’t important, but stroke is our third leading cause of death and our leading cause of acquired neurological disability. That’s a fact and atrial fibrillation is one of the major causes of stroke in Ireland and in Western Europe and that is also a fact. So therefore the pharmacoeconomics have to be set in the context of what the drugs are actually doing. The country has a lot of expenditure on drugs and it is important that we police it, but these are effective drugs. Sometimes I do wonder when it comes down to discussing drugs, for example, cancer, because cancer can be such an emotive issue, the pharmacoeconomics might get looked at, but it doesn’t get the same drilling as a preventative drug, so paring atrial fibrillation back to its core message: It is very common, the consequences of atrial fibrillation can be very severe. Atrial fibrillation can be detected before it causes any major health problems and the health problems can be prevented by effective intervention. The effective intervention is relatively cheap and relatively well-tolerated and there is a huge economic gain in preventing stroke to the health service and a huge personal gain in preventing stroke for people who have suffered one.”
Dr Collins pointed out that the World Health Organisation (WHO) criteria for screening programmes is based on the 1968 Wilson and Jungner criteria that if “a condition is common, that it is easily detectable by an acceptable means, that if you do not detect it, it causes a major health problem, that if you do detect it you can intervene to prevent that major health problem and that it is cost-effective, and atrial fibrillation ticks all these boxes”.
“This is something that causes one-in-three strokes in Ireland. And stroke is our third leading cause of death and leading cause of adult acquired disability so I think atrial fibrillation is a massive public problem.”
He commented that diseases like breast cancer “do not affect 5 per cent of people over the age of 60 or 10 per cent of people over the age of 70, but we have screening programmes. And I’m not saying we shouldn’t have screening programmes for that; that’s not the point I’m making. The point I’m making is that atrial fibrillation is a very serious problem but because it is not directly associated with something with the same emotive or terrifying understanding of cancer [it is overlooked]”.
“So there are other important things we should be screening for and atrial fibrillation is one of them. But in order to have an effective screening programme you must have public knowledge of the issue as well, so that is the starting point. And then we must get engagement with the HSE to look at this for screening. I have to say in Ireland we did a health technology assessment (HTA) of pulse screening [in a general practice setting] under Dr Breda Smyth [Consultant in Public Health, Department of Public Health Galway, HSE Health and Wellbeing Division] in the West of Ireland and the Dáil has approved the pulse check. It is not a comprehensive screening programme, but it has been approved by the HTA, by the Department of Health to be included in the health programme and it is probably part of the ongoing GP contract negotiations.”
However, Dr Collins reiterated that the medical community must further collaborate to raise awareness of the importance of atrial fibrillation. “We have to do our job better, we have to work out a way as to how we get this message across, how do we get people to understand. Once you get public engagement the rest of it tends to fall into place. If you don’t have public engagement you don’t have anything.”
Coming back to this week’s meeting, Dr Collins expressed his excitement at the “world class speakers” who will be giving presentations, including Prof Stefan H Hohnloser, Professor of Medicine and Cardiology at the Johann Wolfgang Goethe University in Frankfurt, Germany, where he is the Head of the Department of Electrophysiology; and Prof Giancarlo Agnelli, Professor of Internal Medicine and Director of the Department of Internal, CV Medicine and Stroke at the Perugia University Hospital, Italy. “They are at the top of their game. It would be hard to get a group of people with such expertise in one room as is being brought to Ireland for this meeting.”
A full exclusive meeting report from the event will appear in a future edition of MI.
Dysphagia can have a “huge impact” on a person’s life, according to Dr Margaret Walshe, Associate Professor in Speech Language Pathology, Trinity College Dublin and Vice President of the European Society for Swallowing Disorders (ESSD).
Difficulty feeding and swallowing is a common problem in preterm infants, children with various neurological problems and craniofacial anomalies, such as cleft palate. It is also frequently associated with acquired neurological conditions, such as motor neurone disease; stroke; multiple sclerosis; Parkinson’s disease; dementia; as well as head and neck cancer.
Speaking to the Medical Independent (MI) from the ESSD Annual Congress in Dublin, attended by around 1,000 delegates on 25-29 September, Dr Walshe said that being unable to eat or drink normally has a profound impact on a person’s quality-of-life and can lead to depression and anxiety.
“It has huge implications socially but it also has implications in terms of aspiration pneumonia, which is the biggest consequence of a swallowing problem, and that is probably the biggest single cause of death in Parkinson’s disease and conditions such as motor neurone disease. It is also strongly associated with malnutrition, dehydration and choking. ”
Aspiration pneumonia in people with dysphagia is often preventable, certainly in the case of acute stroke patients. Research confirms that people with dysphagia following stroke have longer length of hospital stay and poorer outcomes overall than those unaffected by dysphagia, noted Dr Walshe.
Dr Walshe said there has been “a lot of focus” on early screening for dysphagia. However, in terms of patient access to stroke unit rehabilitation, Ireland is “lagging way behind” many other developed countries.
The Burden of Stroke in Europe published in 2017 suggests that less than 30 per cent of patients had access to a stroke unit. Furthermore, according to the report Irish Heart Foundation/HSE National Stroke Audit – Rehabilitation Units 2016, bed access to rehabilitation units was age-restricted for patients in almost half of sites surveyed, while only around 40 per cent of sites had a stroke specialist responsible for the management of stroke patients’ rehabilitation.
According to Dr Walshe, another major issue is lack of access to specialised care following discharge from acute services.
“We have a dysphagia centre in Trinity where, with postgraduate students, we can see patients intensively. With intensive therapy – the patients doing exercises daily and we could see them for four-to-six weeks – they can return to oral feeding. So change is possible and it is even possible a long time after stroke.”
There is a huge unmet need in respect of early supported discharge for patients with dysphagia and a lack of access to speech and language therapy services in the community.
“Some of the acute hospitals in Ireland – including those in the Dublin area – don’t have an outpatient speech and language therapy service, so [patients] go home and they get nothing if the community services can’t pick them up. They might have been on a thickened liquid diet in a hospital, and we see them a year or two later and they are still on a thickened liquid diet, and they no longer need to be. This is especially true for people who have had a stroke or traumatic brain injury.”
Ireland’s only dysphagia research centre runs within the Department of Clinical Speech and Language Studies in Trinity College. The centre has a long history of clinical research in dysphagia, attracting international students to Trinity in order to develop specialist skills in swallowing disorders at a postgraduate level.
Speech and language therapists in Ireland are heavily involved in research around dysphagia, according to Dr Walshe, who feels the next step must be making these projects more multidisciplinary.
“In clinical practice, without a doubt, we have really good multidisciplinary teams; in our research [around dysphagia] we tend to be working in our silos a little more,” noted Dr Walshe.
She added that Dublin’s hosting of the ESSD conference should have a positive impact in this regard.
The Congress heard the latest topical news and views on swallowing disorder research from national and international speakers.
The ESSD is the leading European forum for dysphagia research and is rapidly becoming one of the world’s foremost platforms for the dissemination of clinical dysphagia research.
Among the topics under special focus were approaches to managing aspiration; rehabilitation in dysphagia; new tools to assess swallow function; innovations in dysphagia assessment; interventions in chronic respiratory disease; dysphagia in chronic respiratory disease and dysphagia rehabilitation in critical care.