Inside London's new COVID-free ‘hubs’: Part 1 – a new home for UK breast cancer care

In this episode of 'In conversation with…' we speak with four of London’s most highly-recognised consultant oncoplastic breast surgeons.

Mr Massi Cariati and Mr Petros Charalampoudis from University College London Hospital (UCLH) and Mr Ash Kothari and Mr Hisham Hamed from Guy's and St Thomas' NHS Foundation Trust have all been instrumental in setting up London’s COVID-free cancer hubs. These are sites which have been designed to allow essential breast cancer treatment to continue as normal throughout the pandemic.

Over the course of a two-part interview, they share their experiences of the new initiative so far and tell us how the Magseed® marker has played a part in unlocking significant scheduling and patient benefits to help in the new environment.

We discuss how their efforts and close collaboration have allowed breast cancer treatment to continue across London for patients most at risk.

In part one, we speak about how the idea of the London hubs arose, the unique partnership between the NHS and independent sector that's made it such an effective operation and the challenges they’ve successfully navigated along the way - most notably ensuring patient safety.

Establishing and adapting to the new hub setting

When the pandemic began, the way hospitals operated across the UK was forced to change dramatically. With attention placed on treating patients with COVID-19, resources were drawn away from their operating theatres.

The risks to cancer patients were significant – so determined not to let COVID-19 affect care levels, clinicians began transferring aspects of surgical care to a ‘hub’ system. The hubs meant bringing neighbouring hospitals together to share resources at COVID-free sites.

Designed to be a “one-stop shop” for breast cancer treatment, some of the key guidelines for each hub include:

  • All patients having to self-isolate for 14 days ahead of coming in for their treatment.
  • All patients being screened for the virus 48 hours before their surgery date.
  • Any patients who test positive having their treatment postponed until it is safe to carry out.
  • Wider gaps between appointments and the number of patients in waiting areas area restricted.
  • Facemasks to be compulsory for all patients and clinicians.

Unprecedented help was even provided from independent hospitals, keen to support the pandemic efforts by sharing facilities and equipment.

"There has been fantastic cooperation between the NHS and the private sector which is something I have not actually experienced during my career." Hisham revealed.

"It has allowed us to continue with our work in the best possible way as well as delivering the best - and the safest - possible care for our patients."Mr Hisham Hamed, Consultant Oncoplastic Breast Surgeon Guy's and St Thomas' NHS Foundation Trust

Putting patients first

It wasn't an easy process. Trusts and subspecialties that were not used to working together had to cooperate. Between them, they established a framework to prioritise patients with the most urgent need.

One of their biggest challenge was ensuring patients still came in for screening. With some sites seeing as few as 15-20% of typical referrals, it was clear that patients felt scared and overwhelmed.

Petros, Massi, Ash and Hisham all agreed that the hub could play a crucial role in removing anxiety and help reassure patients that safe healthcare is possible.

"This is the first time I’ve witnessed… truly patient-centred care. Clinicians, priorities, egos, hospital names and badges were all thrown aside." Ash told us.

"All the clinicians pulled together, put the patients first and prioritised the surgery that needed to be done.”Mr Ash Kothari, Oncoplastic Breast Surgeon and Clinical Lead Guy’s and St Thomas’ NHS Foundation Trust

Eliminating COVID scheduling concerns with Magseed®

Keeping the hub COVID-free has been essential. Patients testing positive for COVID-19 are required to wait until the virus has passed before they can go in for their surgery.

This is where the Magseed® marker has proven instrumental in bypassing a number of logistical challenges, such as having to cancel surgeries on the day, should a patient have tested COVID positive.

Pre-COVID, a marker or wire could often be placed at the excision site and operated on later that day. However, with the new hub system, where patients undergo their preparation elsewhere and attend the hub later on for their surgery, the whole concept needed re-thinking.

Approved for long term implantation in any soft tissue, Magseed® allows patients to be prepared in advance at a COVID-free site, then operated on at the hub days, weeks or even months later – again, something not possible with a wire.

"Magseed allowed us to reduce the need for travel, because it allowed us to carry out localisations in advance, on call lists on site at UCLH. This was instrumental in being able to continue delivering breast conserving surgery."Mr Massi Cariati, Consultant Oncoplastic and Reconstructive Breast Surgeon University College London Hospital (UCLH)

Enjoyed part 1 of this episode?

Catch Part Two of the discussion here.

We discuss managing safety across the hubs, their advice to patients to encourage return visits for screening and treatments, plus the various learnings they will be taking from this new collaborative approach – including adapting new technologies.