Other News // 29th September 2021
Other News // 29th September 2021
This Blood Cancer Awareness Month, we’re turning the spotlight on the dedicated band of consultants, GPs and laboratory scientists working away behind the scenes to break down the barriers to early detection, speed up referrals and ensure myeloma isn’t missed.
We caught up with Dr Ross Sadler, Clinical Lead for Laboratory Immunology at Oxford University Hospitals and valued member of the Myeloma UK Early Diagnosis Steering Committee and Lab Best Practices Working Group, about the challenges of analysing and interpreting blood test results, the importance of good communication between GPs, haematologists and the lab and how he is working with Myeloma UK to educate and empower clinical scientists.
I’m a consultant clinical scientist working in clinical immunology at Oxford University Hospitals. I’m the laboratory lead for myeloma and MGUS. This means I am the person responsible for all the tests used to diagnose and monitor myeloma, smouldering myeloma and MGUS.
To be able to diagnose different diseases, doctors and nurses have a few tricks up their sleeves. They can look at the patient and see how they feel, or what hurts and what doesn’t hurt. But once they move past interacting with the patient in front of them, they need to think about what is happening underneath the surface. They can request imaging to take a picture of the inside of the body or the other option is to take blood or tissue samples from the patient and analyse them. That’s where I come in because my job is to oversee and lead a team of people looking at patient blood samples. As an immunologist, I specialise in the analysis and measurement of immune cells, such as white blood cells and antibodies (immunoglobulins). My job is to make sure that every blood sample is handled, analysed and interpreted correctly and that we’ve carried out the correct actions based on those results. And then, most importantly, that the information about those results is delivered back to the clinician or GP in the correct way. This can usually be done via computer, but other times it will require us to phone the GP or clinician who had requested the tests.
I would say there are four big challenges. The first is for the patient to go to the doctor with what are often vague or common symptoms. Then there is the biggest challenge; for the GP is to recognise the symptoms and to think of myeloma as a possibility in the first place. The next challenge is for GPs to request the correct tests. The final challenge is for the laboratory to give the correct advice and recommendation based on the data generated.
A few years ago, my team and I carried out research into which tests were needed to screen for myeloma. We found that GPs were unsure what to do with the results that were generated. For myeloma, you test two or three things, and you might get five or six outcomes. Depending on those outcomes, you might do further tests, or you might not. So, we spent a lot of time mapping out all the eventualities to produce a very transparent pathway for GPs to follow. This is useful for two reasons. It empowers the laboratories, and it helps GPs know what action to take based on the test results.
The UK NEQAS webinars are for lab scientists. They are designed to give them an introduction to myeloma, educate them about the tests used, how to analyse the data and report the results. There is a lot of content in there, including a perspective from a myeloma patient. They also include information and details specific to the clinical scientists and laboratory technicians who are running diagnostic tests. In my webinar, I covered the core fundamentals of testing and reporting results and talked through some specific scenarios and what to do.
I don’t believe that laboratories are there to be a testing service. If you’re a testing service, it means you’re not actually involved in the care of the patient. What you’re doing is picking up a tube of blood, putting it on a machine, pressing a button and making sure the machine is working correctly. I would much rather we were seen as healthcare laboratories, making sure that the patient is taken care of, not just the sample.
To me the answer is IT. Not just in the lab but across the whole of the healthcare system.
IT is great because it enables us to minimise errors. This could be errors in requesting tests, interpretation of results and in decision making. There are already computer programmes that could help filter results and quickly identify the people with abnormal results who need urgent or specific attention. These programmes could take test results from hundreds of patients and flag the patients you need to concentrate on.
We have put out nice, crisp information that’s very accessible for GPs and it would be great to have the same for lab staff that really homes in on the key fundamentals. I also think we’ve got the opportunity here to try and improve the IT aspect – perhaps helping to create pieces of software, with known people in the field, that could deliver some of the functions that we need.