Neuro-oncology

Clinics

Neuro-oncology clinics at Charing Cross Hospital

The neuro-oncology clinics see a range of patients with a variety of different brain and spinal tumour types, who may need to see a range of staff. Some patients are referred at very short notice, and some may need to see specific members of staff. Given this, the clinic can very busy, and patients may be reviewed in a particular order, rather than the order in which they arrive or are scheduled. Most clinics are held in clinic 8, a dedicated cancer clinic on the first floor at Charing Cross Hospital. 

The range of clinics include:

• Oncology clinic (Monday mornings) 
• Skull-base tumour clinic in the main outpatients department (Monday mornings) 
• Joint surgery and oncology clinic (Thursday mornings) 
• Nurse-led follow-up clinic (Friday mornings) 
• Surgical Acute and Surveillance (SAS) Neurosurgery clinic (Friday mornings)

In addition, we offer the option to have remote consultations with patients and families using Attend Anywhere, and daily clinical specialist nurse telephone clinics for patients with queries/concerns via the Macmillan navigator service. 

Address

Clinic 8
First Floor
Charing Cross Hospital
Fulham Palace Road
London W6 8RF

Getting to the hospital 

Please take public transport, if possible. Parking is very limited. Find our hospitals here www.imperial.nhs.uk/ and plan your journey at: https://tfl.gov.uk/plan-a-journey/. If you feel you need support getting to and from hospital, call our transport assessment team on 0330 678 1245 (08.00 to 20.00 Monday-Friday; 10.00 to 13.00 weekends)  

Hours

Clinic 8 is open daily – please check your appointment letter for more details.

Additional information

Please note: If you are seeing one of our team of neurosurgeons, your appointment may be in the main outpatients department on the first floor of Charing Cross Hospital.

Meet the team

Consultant neurosurgeons

Mr David Peterson, clinical director, stroke and neurosciences
Miss Sophie Camp, head of specialty for neuroscience - joint Trust lead for neuro-oncology
Professor Dipanker Nandi
Mr Kevin O'Neill
Mr Pratipal Kalsi
Mr Haider Kareem
Mr Ramesh Nair
Mr Nigel Mendoza
Mr Kevin Tsang 
Mr Christian Ulbricht

Consultant clinical oncologists

Dr Matt Williams, lead oncologist and joint Trust lead for neuro-oncology
Dr Waqar Saleem
Dr Waleed Mohammad 
Dr Alison Falconer

Consultant neurologists

Prof Michael Johnson

Neuro-oncology specialist nurses

Ms Shivani Soni, lead CNS for neuro-oncology and head and neck cancer - joint Trust lead for neuro-oncology
Mr James Tallant 
Ms Giovanna Cella
Ms Fiona Jones  

Allied health professionals

Ms Abby Harper-Payne, neurosurgery advanced clinical practitioner
Ms Davina Richardson, clinical service lead therapist - neurosciences
Mr Graeme Cossou, clinical specialist physiotherapist - neurosurgery
Ms Jasbir Ranu, clinical lead occupational therapist - neurosurgery
Ms Elinor Morgan, specialist physiotherapist - neurosciences
Ms Olivia Honey, specialist occupational therapist - neurosciences
Ms Josephine Schena, specialist occupational therapist - neurosciences
Ms Zasha Mauger Hillier, clinical lead speech and language therapist
Ms Claire Afford, highly specialist - speech and language therapist

Patient information

What are the key things I need to know? 

You are being referred to our services as a recent head scan that you have had at your local hospital has shown some area(s) of abnormality. You will probably have had a CT head, and possibly a subsequent MRI head (this might not have been done yet). A CT Chest/Abdomen/Pelvis may also have been completed. These scans will help to understand if the abnormality is confined to the brain (more likely to be a primary brain tumour) or whether it has developed elsewhere in the body and now present in your brain (metastases). We appreciate this is a lot of information but the appointment with our team will be an opportunity for the consultant to explain the scans to you in more detail and also as a space for you and/or your family to ask any questions and concerns you may have. 

Who will I be seeing in clinic? 

If you have been newly diagnosed with a brain tumour of any sort we would normally aim to bring you to our Thursday morning multi-disciplinary clinic (as long as you are well enough to attend), although some patients are seen in our Monday or Friday morning clinics instead. We would encourage that you attend this appointment with your next of kin, family member or close friend. There will be a consultant(s) familiar with your case present at these clinics and you will also be introduced to one of our Clinical Nurse Specialists. These clinics will be busy but we want to ensure you see the most suitable member of the team and have enough time to discuss all of your concerns, therefore, you may have to wait for some time to see the most appropriate member of the team for your specific case. We appreciate that you and/or a family member may not always be able to make the commute to us and where appropriate we will offer you a video clinic appointment. The website for the video clinic is https://nhs.vc/Imperial-Neuro-Oncology 

After your appointment/ Further resource 

Following your scans and any other necessary investigations, your case will normally be discussed in the multidisciplinary team (MDT) meeting where neurosurgeons, neuro-radiologists, clinical oncologists, nurses, physio/occupational therapists and others come together to decide upon the best course of treatment for your needs and condition. We will contact you to discuss your treatment plan.  

We offer a range of clinics on different days and times, including video calls and telephone clinics. Not every clinic is suitable for every patient, but please let us know if one clinic suits you better than another, and it may be possible to adjust your appointment. 

Both Macmillan Cancer Support and Brain Tumour Charity websites are good sources of advice and support. Here at Charing Cross Hospital, Imperial College Healthcare NHS Trust, we have a dedicated Macmillan Cancer Support office on the ground floor of the hospital. There is also the Maggie’s cancer charity building (orange one) on the Charing Cross Hospital grounds which can offer you and/or your family support that fits your needs. They are open Monday to Friday 9am to 5pm and have a range of support specialists, psychologists and benefits advisors to help you find your way to live with cancer.

Website: www.maggies.org/our-centres/maggies-west-london
Telephone: 020 7386 1750
Email: london@maggies.org.

They have a timetable of events/ sessions which you can either just drop in on or pre-book and a mix of online and in person sessions. To see their timetable follow the link.

Furthermore, The Brain Tumour Charity have their own app, “BRIAN”, which you can download and use wherever you currently are and it can be used further down your pathway to track your own progress through treatment. You can also use this app to access discussion boards to get advice and support from other patient and healthcare professionals including the neuro-oncology team from Charing Cross hospital. Further information on Brain.

Physiotherapy

Physiotherapists help patients with issues that affect their breathing, movement and mobility. It is possible that the tumour can affect the areas of your nervous system which control these. To support optimum treatments for you Physiotherapists will often assessing a number of areas such as breathing, strength, sensation, coordination, balance and muscle stiffness to establish how best to help you manage your day to day tasks. Treatments often involve advice, exercise practice and advice on how to manage fatigue and conserve your energy.

Physiotherapists are also involved with respiratory care, helping to keep the chest clear of secretions and the lungs working properly for those who have developed difficulties with their breathing. Physiotherapists will often involve family, friends and carers in supporting management of recommended exercises and strategies.

Occupational therapy

Occupational therapists will work with you to assess and optimise your independence in activities of daily living. These activities may include eating, washing and dressing, preparing a meal, shopping, using your phone or working.

Assessment is focused on your cognitive, physical, sensory and perceptual abilities that may impact your function in day to day activities.

Occupational therapy is individualised and may include education, task practice and/or modification, teaching compensatory strategies, provision of aids or equipment. Intervention may also include carer training and providing advice to family or friends to optimise your independence.

Dietitian

Dietitians work closely with the multi-disciplinary team. They can assess, diagnose and treat dietary and nutrition problems. Dietitians will advise you on a variety of food and health concerns, for example: unintentional weight loss.

You may be referred to see a dietitian for your nutrition needs. As an in-patient, referrals may be based on a nutrition screening process. The focus tends to be based on unintentional weight loss. Following a diagnosis from neuro-oncology, there may be other concerns, like swallow problems, or other issues. You may need to put on weight following a time of ill-health or as a result of a medical condition. You may suffer from additional long term conditions, like coeliac or diabetes. You, or your carers may want practical advice to ensure you are getting appropriate nutrition in their diet, which the dietitian can support you with. 

If you have any concerns, your nurse, therapist or the doctor’s team may want you to see the dietitian. Equally, if there are any nutrition concerns, an individual is always welcome to self-refer to dietetic services. In the community setting, your GP can refer you to a dietitian nearer to home.

Speech and language therapy

Speech and language therapists (SLTs) are responsible for assessing and providing individualised therapy for speech, language, communication and/or swallowing difficulties. The extent of which communication or swallowing may be affected will depend on the location of the tumour within the brain. Information might be presented in an alternative means, in order to support you to understand your diagnosis, treatment and prognosis.

The SLT works closely with the multidisciplinary team, patients, families, and carers to provide advice and education, on how to support communication effectively. This may also include supporting you to make decisions regarding your diagnosis and treatment.

If you are having difficulties with swallowing (dysphagia), the SLT will assess and monitor your swallowing, providing recommendations on alternative textures, strategies that may improve the safety of the swallow, in addition to any appropriate rehabilitation exercises.

Ongoing support

If you require surgery, you may need on-going support after your surgery or because of the impact of the tumour. This can occur in several different ways depending on your needs and what is provided in your local area:

• As an inpatient at a local or specialised rehabilitation unit
• On one of the wards at your local hospital
• In your own home with a community team
• As an outpatient at your local hospital or at NHNN

All referrals will be discussed with you and/or your family before they are made.

Patient information leaflet

• GAMMA KNIFE
• STEROIDS
• Using questionnaires for brain tumour patients
• Welcome to clinic letter
• Maggie’s leaflet
• Trust SRS leaflet 

Clinical Trials 

At Imperial College Healthcare NHS Trust we are very research active and you may be approached by a member of our research team to take part in one of our Neuro-oncology studies. We have several observational and imaging studies (definition) as well as some interventional studies (definition). Your decision to take part will not affect the treatment that you receive. Some of the studies that we currently have open and are recruiting to are: 

Interventional Studies 

• FUTURE-GB 
• PARADIGM 
• SPRING 
• BRIOCHE 

Observational Studies 

• BrainWear 
• BrainApp Imaging Studies 
• MRI Fingerprinting 

Imaging studies

• PET Study 
• TeTRa 

Refer to this service

GP referrals

GPs should use the two week wait referral pathway for standard referrals to our neuro-oncology service.

Urgent referrals should be made through the on-call referral system via the on-call neuro-surgical registrar. To do this, please call 020 3311 1234 and ask the operator to bleep the on-call neuro-surgical registrar (bleep 8075).

Two week wait cancer referrals — click here to learn more

MDT Discussions

At our MDT meeting we have representation from numerous professionals from a range of specialties including neurosurgeons, neuro-radiologists, clinical oncologists, pathologists, neurologists, clinical nurse specialists, physio/occupational therapists, staff in training and members of staff from other hospitals in the region. We discuss cases referred to us, determine treatment options and review follow-up imaging if needed.

The Neuro-oncology MDT meetings are held twice weekly (Wednesday 3pm-5pm and Friday 1pm – 2pm). To refer a patient for discussion please email Imperial.braincns.mdt@nhs.net providing us with as much information as possible including their performance status, past medical history and if they have a known primary cancer details of their oncologist and treatments they have received.

Advice

Patients and carers should contact the Macmillan navigator service.  This is a telephone service which acts as a single point of contact to help you throughout your care. Navigators can provide a range of information, help and support, such as checking your appointment dates and altering these if required. When calling, please let the navigator know that you would like to speak with a Brain Tumour/ Neuro-oncology CNS. The navigator service is available Monday to Friday 08.00–18.00 and 09.00–17.00 at weekends. Telephone: 020 3313 0303  

Secretary: For oncology related question please contact claire.farrell7@nhs.net or 020 3311 8427 and for neurosurgical related questions please contact davina.mcdaid@nhs.net or 0203 313 5521. If you question is related to an appointment or if you need to be in contact with the nursing team please use the MacMillian Navigators. 

GPs and healthcare professionals only: Email: IMPERIAL.BRAINCNSNURSING@NHS.NET  or phone ‘The BrainCell’: 07826 917492 Monday through Friday, 08.30 to 17.00.  For MDT outcomes email:Imperial.braincns.mdt@nhs.net

Additional clinic information for GPs

Patients who are referred urgently will be discussed with the oncall neurosurgical registrar and consultant, and the neurosurgical registrar on call will contact the referring doctor directly. 
 
We run a joint neurosurgery-oncology clinic on a Thursday morning, and both skull-base and oncology clinics on a Monday morning. There is a nurse-led clinic on a Friday morning, as well as a Surgical Acute and Surveillance (SAS) Neurosurgery clinic. Letters will be dictated from clinic and made available electronically via the Trust clinical document library for participating GPs. Otherwise they will be posted out as standard. 
 
Patients are also given written information, including contact details, when they are seen in clinic (see below). MDT proformas are also sent to the GP, and this contains information relating to a patient's presentation history, imaging and histopathology findings, and a discussion of the MDT outcome and the treatment plan for the patient. 
 
For clinical queries, please contact the clinical nurse specialist team (details above).                          

Following admission to a local hospital 

Many patients with brain tumours will develop symptoms or be admitted to a local hospital as an emergency. We are always keen to hear about them and offer help where we can. Oncology, neurosurgery and neuro-oncology specialist nurses are all based at Charing Cross Hospital. If the patient is acutely unwell, liaise with your local acute general medical team (via emergency department /medical team), acute oncology service and stabilise the patient (steroids, anti-epileptics). If you have any patient pathway related issues or concerns, please contact our Neuro-oncology Network Relationship Manager on lillie.shahabi@nhs.net.  

For new referrals from secondary care, please use the ReferaPatient online portal and call the on-call neurosurgical SpR. Please email our MDT coordinator, Imperial.braincns.mdt@nhs.net details of the patient to ensure they are discussed the MDT meeting 
 
If you are a healthcare professional and need advice on existing patients please email or phone our Neuro-oncology CNS team on the BrainCell, 07826 917492 (Monday through Friday, 08.30 to 17.00) or via email at imperial.braincnsnursing@nhs.net. 

 For advice on existing patients please email or phone our service using the contact details listed above.