Norfolk and Norwich University Hospitals are marking the successful establishment of the UK’s only gynaeoncology programme administering heated chemotherapy at the time of surgery (HIPEC- heated intraperitoneal chemotherapy) for patients with ovarian cancer.
Since establishing the service two years ago a multidisciplinary team has completed 40 cases, recording good outcomes for their patients. This has been achieved by the efforts of a vast multi-disciplinary team including consultants, senior ward staff, nurses, health care assistants, pharmacists, occupational therapists and admins and clerical staff across our surgical and medical division.
HIPEC is a procedure carried out following the completion of complex surgery to remove all visible disease in the abdomen and pelvis. After the initial procedure has been completed, a 40-42°C solution is washed through the patient, in an attempt to kill off any remaining cells.
Patients have to meet very strict criteria to be eligible; their cancer must be advanced but not spread to other organs unless it is a different type of cancer and not linked to the first. They must also be assessed fit enough to undergo the gruelling major surgery.
NNUH Consultant Gynaeoncology Surgeon, Nikos Burbos, has led on this programme with collaboration from NNUH Consultant Colorectal Surgeon, Adam Stearns, who already provides this service for colorectal cancer patients.
Mr Burbos said: “At the moment we are treating 20-30 of our most advanced ovarian cancer patients a year. These are people who have the most aggressive form of cancer, but who we feel benefit from this procedure.
“This is also a procedure which comes with a lot of risks and therefore needs a highly specialised team to be able to carry it out:
- We are bringing dangerous chemotherapy drugs into our operating theatres which then have to be washed around the patient’s abdomen
- We are heating up a solution to a very high temperature, but need to make sure that the overall body temperature doesn’t rise, which could be very dangerous
- Body cooling blankets have to be applied throughout the procedure along with ice fluids washed through intravenously to stop the patient over-heating
- Most importantly, HIPEC needs to be done by highly specialised surgeons, as removing all the visible cancer is the most important part of the procedure
“We require highly specialised anaesthetists to be alongside the patient throughout. These are trailblazing anaesthetists who we have on board here.”
The experience at NNUH means the Trust is the only established centre in the UK to offer this service to ovarian cancer patients as part of the standard care. Recently, two other centres in England have started treating patients with ovarian cancer– The Christie in Manchester and the Royal Marsden in London.
The development of this service has been more than 10 years in the making and requires a huge level of collaboration across multiple teams including nurses, HCAs, pharmacy, oncologists, anaesthetists, intensive care team and various surgical specialties.
Mr Burbos said: “We have been carrying out this procedure for nearly two years and we are extremely pleased with the outcomes we have seen. Research data from Europe suggest this procedure is extending patient lives by a year on top of their expected survival rates.
“This has been a very long time in development. First, we had to make sure we established a robust infrastructure for advanced ovarian cancer surgery before we could even entertain the idea of extending this to offering HIPEC.”
He added: “We would not have done this without having Adam Stearns here at NNUH. As our lead Consultant Colorectal Surgeon, his vision and drive to develop cancer services has allowed us to embark on this project – and we have been able to realise this project because of the huge efforts of all involved to learn about new procedures, understand the enormity of what we are trying and to visit other centres in Europe who are already well-established in this field. And then there is no easy way to learn this. It takes years of collaboration between colorectal, pancreatic, gastro, urologists alongside gynaecology to develop this into an established service.”
Mr Stearns said: “This has been an enormous team effort with everyone involved invested in developing a service which is demonstrating real benefits to our patients. It could not have been possible without the generous support of the Norfolk and Norwich Hospitals Charity and the Friends of NNUH, who gave £50,000, as well as donations from Norfolk businesses, insurance specialists Alan Boswell, and charity supporter David Geiss.”
N&N Hospitals Charity’s Head of Grants, Julie Cooper, said: “The Norfolk and Norwich Hospitals Charity are delighted to have been able to fund the purchase of the HIPEC, thanks to money transferred from the Friends of the Hospital when they closed their charity. This is yet another example of our local community donating to support improvements at our hospitals, over and above what the NHS must fund, and we are very grateful to everyone who has made this possible.”
NNUH Medical Director Professor Erika Denton said: “This is an incredible example of extensive collaboration to provide better outcomes for our patients. This also means we can lead the way in developing these services for other trusts across the country.”
NNUH Chief Executive Sam Higginson said: “This is NNUH at its best. Our approach was that we wanted to be the best for our patients and being innovative is the best way to achieve that – and what makes this even more impressive is that we did this throughout a global pandemic.”
- Thanks to generous donations from our local community, the N&N Hospitals Charity is able to help the N&N, Cromer and Jenny Lind Children’s hospitals do ‘more’ for NHS patients. To find out more about the N&N Hospitals Charity, or to make a donation, please visit www.nnhospitalscharity.org.uk
Annette Mills, 65 who lives in North Norfolk, was the first patient at the Norfolk and Norwich to have the HIPEC treatment having been diagnosed first with breast cancer in 2019 and
then ovarian cancer.
The two cancers were not linked, and Annette was eligible for the treatment. The procedure was carried out while she underwent a 13-hour operation which involved a mastectomy, hysterectomy, appendectomy, omentectomy (removal of the fatty tissue around the internal organs), removal of her spleen and a small part of her bowel.
“It’s an experience I would rather not have had, but when you are offered something that could save your life you’ve got to do it,” said Annette.
She added: “Everyone went through everything with me before hand and, of course I don’t remember anything. I was talking to the anaesthetist and the next thing I knew I woke up and I was really quite well. The doctors and everyone were astounded by how well I was doing.”
Annette was in hospital for eight days and allowed home.
Her treatment continued with four chemotherapy sessions for the ovarian cancer and 15 radiotherapy sessions for the breast cancer.
“It took me a couple of weeks to get back to my usual self and the radiotherapy was quite tiring, but generally I have been really well.
“Of course, at the beginning I was a bit trepidacious, because this was a big operation, and I was the first one to have it at the N&N. Actually because of that there were a lot of people in the operating theatre. I said to Mr Burbos that this was my 15 minutes of fame, and I was going to be asleep!”
Annette added: “I am so grateful. I have not looked back. I wake up every day and think, great, here we go again with another day.
“Anyone offered this? Go for it.”