Thank you for inviting me to give evidence to the committee. Eye melanoma is a rare cancer, but it is absolutely a very important condition. Our service in Scotland takes the condition very seriously and the support of our patients is something that we care a lot about.
First, I would like to clear up something that has, I think, been unclear from the beginning. The premise of the petition is that there is a difference between Scotland and the rest of the UK. I have to disagree with that. There is a problem in the UK with a consensus as to how surveillance should be undertaken, but that is not a Scottish issue; it is a UK one. I would like to make that very clear.
I tried for many months to engage the other three ocular oncology centres in the UK—in Sheffield, London and Liverpool—to try to get a UK-wide consensus, because that is the best way forward to provide clarity for our patients. Unfortunately, I was not able to get engagement from the other three centres. I do not know why, but that is the situation that I faced. I therefore felt that we needed to press ahead in Scotland and come up with our own consensus statement, which I suspect will have quite an influence on the rest of the UK and perhaps further afield.
The statement group had representation from patients. We had a patient representative—Ronnie Blair from Scotland. We also had an English oncologist, who is a general cancer specialist—not just an eye cancer specialist—with an interest in eye cancer, three Scottish oncologists, an English ocular oncologist, two Scottish pathologists, two Scottish radiologists, me, and my colleague Vikas Chadha.
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This was not an attempt to draw up guidelines, but an attempt to bring together a consensus statement. That is an important point, because we already have guidelines from 2015 that we cannot override. Our work has to complement those guidelines, if you like. The problem with the guidelines from 2015 is that they were left quite vague because the group could not agree on a protocol that all the centres could follow. The main reason for the disagreement was the lack of evidence and consensus.
The recommendation from those guidelines was that a non-ionising form of radiation be used to image the liver every six months. That is a vague statement. The two forms of non-ionising radiation are ultrasound and MRI scanning. We needed to try to clarify that statement for our patients in Scotland. Unfortunately, despite an updated review of the literature from 2015 that takes account of the four years since then, there is still a lack of evidence that MRI surveillance alters life expectancy for our patients with eye melanoma. Furthermore, there is no curative treatment for patients who develop spread of this type of cancer. Although there are lots of new and exciting treatments, the evidence is still—unfortunately—lacking that any of them make a difference.
There are, however, many exciting clinical trials. We are very excited about them and we want to be at the forefront of allowing our patients to access them. The Beatson unit, which is in the building next to where I work, is very much part of that.
The group decided to adopt a risk-stratified approach. I have read most of the Public Petitions Committee’s previous discussions about the petition, and in one of the discussions it was suggested that we are unable to stratify risk in Scotland. I absolutely refute that. Every single one of our patients has a risk attached to their tumour, and it is not correct to say that we have to have a biopsy to have that risk stratification. There is a very accurate way of stratifying risk based on size and location of tumour, so we know the risk of all our patients who come through in Scotland.
One of the main drivers is that we want to allow our patients to access the clinical trials. We decided that we would adopt a high-risk/low-risk strategy where the high-risk patients would be offered MRI scanning every six months and the low-risk patients would continue as at present, getting liver ultrasound and then going on to MRI scanning if required. There is no risk-free aspect to this. MRI scanning has many risks, which I might discuss later.
We feel that we have reached as far as we can with a group of clinicians and a patient representative to try to come up with a pragmatic approach for our patients in Scotland and to allow our high-risk patients to access the exciting clinical trials that are coming online, and also the liver-directed and systemic treatments that are available for them. I feel that the consensus statement is a real step forward in clarifying the situation for our patients. At least we in Scotland will be able to say that this is the line in the sand for our patients.
The report has been approved by the national services division in Scotland. It has been circulated to all the health board chief executives around the country, and it is now up to the boards to decide how they are going to implement the protocol—the statement. Thank you.