Promoting Change in Cancer Services

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• Promoting Change in Cancer Services

Dr A Gavin N. Ireland Cancer Registry
Tel [phone] Fax [phone]
E.Mail nicr_at_qub.ac.uk Website
www.qub.ac.uk/nicr
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Promoting Change in Cancer Services

• Background
• Methods and Results
• The Cancer Registrys Role in Promoting Change

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UK and Ireland
N. Ireland Population 1.7 Million
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N. Ireland 1996
22 Hospitals
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Centralisation Improves Outcomes

• Calman Hine report 1995 (England and Wales)
• Campbell Report 1996
• Organ and disease specific specialists
• Multidisciplinary multiprofessional specialist
  cancer teams
• Centralisation of services to Cancer centre and
  cancer units

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1997 5 Cancer Units, 1 Cancer Centre
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Study Aim

• To compare process of care and outcomes 1996 (pre
  Campbell) and 2001
• Method
• Retrospective note review by trained Registry
  staff of cases registered NICR Electronic
  Proforma for data entry designed with clinicians
  taking account of existing guidelines
• Oesophagus stomach, lung, colon and rectum,
  breast, pancreas (2001), cervix, ovary, thyroid
  (2001/2002)
• N4000 approx. gt60 cancers

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Data Collected

• Patient
• Demographics
• Referral source
• Symptoms and duration
• Comorbidities
• Medication
• Investigations
• Staging
• Treatments
• No Treatments

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Data Collected

• MD Meetings
• Operator Workloads
• Procedural Intent
• Waiting Times
• Onward Referral
• Communication
• Patient
• GP
• Outcomes
• Survival Stage, Cell Type

• Patient
• Demographics
• Referral source
• Symptoms and duration
• Comorbidities
• Medication
• Investigations
• Staging
• Treatments
• No Treatments

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Lung Cancer Patients

• 75 referred by GP
• lt1 referred from Radiology
• 40 emergency admission

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Lung Cancer

• 1/10 under 55yrs at diagnosis
• 5 non-smokers
• Higher in deprived group
• 1/3 Significant Comorbidity - 1/3 Heart Disease -
  1/3 COPD - 1/13 Stroke
• 1/13 history of other malignancy

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Lung Cancer
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Lung Cancer Observed Survival Surgery Versus Non
Surgery Patients
55
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Surgery patients survival plt0.01 (n113 in 1996,
92 in 2001)
Overall survival unchanged
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Breast cancer - Hospital of Operation
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Breast cancer - Hospital of Operation
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Tamoxifen prescription and ER status of patients
Tamoxifen prescribed 97 1996 surgery patients
76 2001 surgery patients
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Breast by 2001 compared with 1996

• Earlier disease presentation
• Reduced waiting times
• Better staging information
• More specialisation
• Better targeting treatment eg Tamoxifen
• Improvement in information to GP

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Colon, RS Rectum (conclusions)

• High emergency presentations (38 CRS 16
  rectal)
• Duration serious symptoms
• Use of CT Scanning
• Improved Staging Node exam
• MDT Meetings increased (18 CRS 31 rectum)
• Evidence Centralisation
• rectal
• More high volume operators
• Referral times steady volume increased
• Improved recording information
• In notes
• To GP

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Key Issues Colorectal Cancer

• Too many operators
• 90 colon in 2001
• 39 rectal
• 24 less than 5/year CRS, 22 rectal
• Too many hospitals
• 16 CRS
• 14 Rectum
• Need to further improve staging
• Need to increase MDT meetings
• 20 stoma patients no record of stoma therapist

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Pancreas

• Treatment for patients with Pancreatic Cancer
  should be the responsibility of Specialist
  Pancreatic Cancer Teams. These should be based
  in Cancer Centres and serve populations between
  2-4 million
• Improving outcomes in upper GI Cancer NHS 2001

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Pancreas (n152 patients)Key Issues

• 48 surgical procedures for pancreatic cancer were
  performed on 31 patients by 18 surgeons in 11
  hospitals in N. Ireland in 2001.

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• RACC Reports
• Oesophagus Stomach, Breast, Prostate,
  Colorectal, Lung and Pancreas

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Value of Audit Reports

• All patients diagnosed with major cancers so a
  population perspective
• Data of value to clinicians
• NICaN Working Groups established as a result of
  the gaps demonstrated
• Promises to improve cancer services via audit
  loop
• Valuable for clinical governance
• Waiting times information
• Goal Series of Snapshots of Cancer Services
  1996, 2001, 2006

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Promoting Change in Cancer Services the role of
cancer registries
Identify problem or issue
Monitor effects of change
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All reports and proformas available
at http//www.qub.ac.uk/nicr/racc.htm