National advisory panels (NAPs) advise teams on the best treatments for complicated cancers. Dr Jessica Bate, a consultant paediatric oncologist at University Hospital Southampton, explains more and tells us about her recent research evaluating their impact.
In the UK, multidisciplinary teams (MDTs) are a central part of children’s cancer care and are included in the NHS Cancer Plan. All children with a cancer diagnosis have their care reviewed by an MDT at a principal treatment centre, with the team typically including oncologists, surgeons, radiologists and nurses. MDTs can help to make evidence-based treatment decisions, coordinate care and
education for team members, improve patient outcomes and increase clinical trial recruitment.
National advisory panels (NAPs)
Over recent years, national advisory panels have arisen, made up of national experts for a specific cancer type. These panels are different from local MDTs. A child’s consultant can request personalised advice from these panels - for example, in patients with rare cancers or who have relapsed. There is increasing demand for patients to be discussed at NAPs with more being referred year on year. National guidelines for certain cancer types recommend referral to panels.
NAPs are run on the dedication and goodwill of the NAP chair and panel members, who can include different cancer care professionals. The meetings are attended by the patient’s referring consultant, to present their case and relevant clinical information. The patient is then discussed, with recommendations made and shared with the patient’s family. The final decisions on how to proceed with treatments are always decided by the referring clinician, in discussion with patients and families.
MDTs can help to make evidence-based treatment decisions, coordinate care and education for team members, improve patient outcomes and increase clinical trial recruitment.
Our research
While NAPs clearly fulfil an important role, their remit and impact on patients haven't previously been studied. Based in Southampton, Dr Sarah Brown and I have worked on a CCLG-funded project
to formally evaluate these panels and recommend best practice guidelines.
We looked at 920 existing referrals made to six NAPs, who have all discussed hundreds of cases. The evaluation highlighted the time and effort that NAP panel membership entails and the impact the panels have on the management of patients.
We found that doctors followed NAP advice around 90% of the time and, if they didn’t, it was usually due to the patient’s family and their wishes. Parents don’t attend the NAP meetings but do
play a huge part in a child’s treatment. One of our goals was to help families understand panels’ decision-making processes and to find out how best to involve parents in these decisions.
As part of this project, Sarah developed guidelines which set out ways the panels could improve and streamline their process. As part of this, she worked with parent and patient groups, to suggest ways to involve the family in NAP decisions. This included adding fields to the referral form, like whether the patient or their parents were hoping for a particular result, or to avoid a certain treatment.
Other recommendations for NAP best practice included making sure enough members attend meetings to give a fully debated treatment plan, being clear about how and why a recommendation was made and making sure that the referring doctor can represent the patient’s views and wishes accurately.
What's next?
For NAPs to be sustainable, there needs to be a strategy to provide support and formal recognition of panel work within job plans. Prior to our project, there were no formal guidelines or standards against which to benchmark the NAPs and no currently established system for review of practice. By producing best practice guidelines, we hope that both existing and new NAPs will utilise them
to assess their performance and to drive improvement in children’s cancer care.
From Contact magazine issue 98 - Spring 2023
