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Using Artificial Intelligence To Aid Radiotherapy

Northampton General becomes first hospital to treat head and neck cancer using artificial intelligence

 

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Dr Craig Knighton looks at a treatment plan in progress Credit: Northampton General Hospital

Radiotherapy patients at Northampton General Hospital are among the first in the UK to be benefiting from the use of artificial intelligence. It’s being used to determine the best treatment for head and neck cancer, a particularly complex area to treat due to the proximity of radio-sensitive organs like the face, spine and brainstem.

The revolutionary software, called ‘RapidPlan’, learns from the last 100 treatments at Northampton General to generate an individualised plan for new patients.

Not only does this new way of working provide patients with the best possible treatment for their needs, but with minimal human interaction, it saves time. Before this, clinicians and medical physics staff would have spent time analysing scans to decide on a treatment that satisfies the many rules for a plan.

“Using this new technology gives our clinicians instant access to the information stored in previous treatment plans, to generate high quality treatment plans in a reduced timeframe. This will allow shorter waiting times and increased numbers of patients treated.”

– DR CRAIG KNIGHTON, CLINICAL DIRECTOR OF ONCOLOGY AND HAEMATOLOGY

The hospital hopes the new system, made by the company Varian, will help create more consistency across departments. Staff are also looking to create a supermodel for radiotherapy treatment across the country.

(From an ITV report)

Patient Experience Surveys

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How do head and neck patients fare in comparison with others?

Head and neck cancer is considered a “rare” cancer. Because the patient numbers are low compared to say breast or prostate cancer it can be difficult to gather meaningful information because sample sizes in surveys are too low.

The National Cancer Patient Experience Survey has been running for some years and the latest included returns from almost 2000 head and neck patients. Even so, results for our patients from individual trusts are problematic due to the small sample size for each and little information is available. Statistically significant results are only presented for the whole country.

Care is needed in comparing the experiences of patients having different cancer types. Differences in the care pathway, including preferred treatment modalities, will lead to differences in the response to particular questions in the survey. However some interesting differences are evident in the results. Looking back at previous surveys as well, the same differences have been seen in previous years.

When asked about the time between them noticing something suspicious to consulting a GP, 8% of head and neck patients reported a delay greater than 6 months. 3% of breast cancer patients gave the same answer.

A similar divide was seen after the visit to the GP. For 18% of head and neck patients it took 3 or more GP visits to get a referral to a hospital but just 3% of breast cancer patients needed this many.

When asked if they were given written information about their cancer, in a form that was easy to understand, 50% of head and neck patients responded positively. The corresponding figures for prostate and breast cancer were 74% and 70%.

These differences do not necessarily reflect failings in treatment and care; they will also result from the varying challenges of dealing with cancer at different tumour sites.

For patient support and advocacy groups, the results of the survey are valuable in assessing priorities and from the examples above raising awareness about head and neck cancer stands out.

The NCPES provides valuable information and would reward deeper analysis than presented here. I do hope the NHS will continue to fund this work and it does not go the same way as the head and neck audit (DAHNO) and vanish.

Link to Full Survey Results

 

Throat Cancer Early Signs

The linked article below is a comprehensive and useful guide raising awareness of head and neck cancer symptoms. Though the focus is on laryngeal and pharyngeal cancers, there are links to information about other head and neck cancers. Though the scenario is the USA,  it is equally relevant for the UK.

What to look for

There is ample evidence of the serious consequences of delaying treatment. The risks are currently enhanced by  a reluctance to seek medical assistance, especially by men, and the current pressures on the NHS, leading to a failure to meet targets for treatment deadlines.

Ensuring information in this article is spread as widely as possible has to be a priority if lives are to be saved.

Overcoming Swallowing Problems

Functional problems after treatment for head and neck cancer are the bane of so many patients lives. Speech is inevitably an issue, especially for laryngectomees, but swallowing problems  cause so much distress as well.

I recently met a laryngectomee who has never found an alternative voice, aside from phone apps. Now, six years down the line, he has additionally begun to experience problems with swallowing.

Researchers at the University of Alberta in Canada have developed a device that can extend the swallowing function  from liquids only to a more normal diet.

Report

It is early days and the research only involved a small number of patients but hopefully such strategies will enable future patients to have a better quality of life after treatment.

Head and Neck Cancer Good Practice

There are plenty of sources of information describing best practice in the treatment of head and neck patients. They range from the 2015 document  “Achieving World Class Outcomes”, many NICE guidelines and quality statements and the 2012 NHS document “Nothing About Me Without Me” .

A recent article in the Nursing Times describes the head and neck pathway at UHNM, in Stoke.

ARTICLE

There are many impressive features of the care they provide and I especially like a couple.

The team provide their patients with peer support, stratified into 3 streams head and neck, laryngectomee and thyroid.

Secondly there is an emphasis on patients being involved in decision-making about their care. Choice between alternative treatment options is highlighted in NICE guidelines and the patient view should figure highly in any such  discussions.

 

Cancer Treatment Delays Affect Outcomes

I don’t think there would be much argument about the title of this post. It seems to be common sense.

Many factors contribute to a delay, beyond the 62 day wait between urgent referral and start of treatment. The increase in demand for treatment and the shortage of key staff are particularly important here. Along the patient pathway a shortage of radiology and imaging staff is but one potential source of delay.

A recent study has highlighted the importance of meeting the target, with worse outcomes when this does not happen.

study

I am sure patient groups will want to stress at every opportunity that meeting the cancer target times has to be of the highest priority.

Laryngectomy – a thing of the past?

A recent post on the website of the Mayo Clinic (USA) talks about the need for patients to have a laryngectomy in future years.

Article

Being a bit pedantic, everything discussed still involves the removal of the voicebox but what may be avoided is the need for a neck stoma. Like many articles I read it portrays having a laryngectomy as a bleak outcome.

For some a laryngectomy, after a diagnosis of late-stage cancer, is a procedure that brings precious months or years survival. For others it enables them to return to a full life in most respects. There may be some problems with speech and swallowing but this is true for many head and neck cancer patients.

Two alternatives are presented but both have limitations. Larynx transplants are unlikely to be a viable solution , not least from the problem of finding sufficient donors and the handicap of needing immuno-supressive drugs for life.  Regenerative medicine, using stem cells has the advantages of needing no donor or drugs to combat rejection. However my understanding is that these techniques will need many more years before providing a practical solution.

One approach that is not mentioned is to develop an artificial robotic larynx, but like regenerative medicine many years more will be needed to develop a viable device.

Rare Head and Neck Cancers

A new charity has been set up  – Salivary Gland Cancer UK. It aims to set up a support and information network for patients and those treating them.

website

Patients who have a rare cancer face additional problems. It can be difficult to find the funding needed for research in to causes, identification and treatment, Getting sufficient numbers for a clinical trials can be near impossible. It will also be far more difficult to find relevant peer support.

The charity aims to build alliances with other groups working to support those with rare diseases.

NHS Funding To Meet Laryngectomee Needs

For some months there has been publicity about the increased funding the NHS will receive in future years. This is welcome but there is evidence that current funding constraints mean our needs are not being met for now.

I am aware of a laryngectomee support group that has recently raised a four figure sum to allow for the provision of an electrolarynx for patients in their locality. Why is this necessary?  Would a patient needing a prosthetic limb need funds from a patient group to provide it?

A laryngectomee with a voice prosthesis may experience a leakage when eating or drinking. This requires the prosthesis to be changed by a nurse specialist or (more often) an SLT. In the meantime the patient cannot eat and drink as usual. I am aware of patients having to wait for several days before the problem can be rectified. When I had my laryngectomy in 2002 all I had to do was turn up to the ENT clinic in the event of a problem and it would be resolved on the day.

My comments should not be taken as a criticism of clinical staff, we are all aware of the pressures they face in delivering the patient care they would wish to provide.

I was astonished to learn of the extent of the continuing problems through lack of funding, which may have serious consequences for cancer patients in particular.

GP referrals to hospitals

I know NALC and the Cancer Laryngectomy Trust are working to highlight the needs of their members.

Radiotherapy Provision

Action Radiotherapy has published a report on current provision  of radiotherapy across the UK.

REPORT

Many interesting questions are posed about how well the needs of patients are being met. I remember discussions in the old North Trent Cancer Network head and neck group about how demand would out-strip supply quite quickly. That was some years ago and still there is just one centre, in Sheffield.