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National Head and Neck Cancer Audit

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National Head and Neck Cancer Audit National Head and Neck Cancer Audit Key findings for England and Wales for the audit period October 2007 to November 2008 DAHNO fourth annual report Prepared in partnership with: National Head and Neck Cancer Audit National Head and Neck Cancer Audit Key findings for England and Wales for the audit period October 2007 to November 2008 This fourth report for the National Head and Neck Cancer Audit presents data collected on new registrations from 1 November 2007 to 31 October 2008 and treatment data up to 23 November 2008. The report reflects findings form the analysis of that data, and provides recommendations for improving data quality and completeness. The National Head and Neck Cancer Audit aims to improve both the volume and quality of data submissions, and from this, provide comparative feedback to NHS Provided Trusts, with the ultimate aim of improving patient care. This year the annual report is only available in electronic format, but is accompanied by a brief printed summary report which will be widely disseminated. An in depth more detailed reference report is also available electronically from the website below, configured for those interested in cumulative data, extended analysis and more extensive references. Electronic copies of both these versions of this report can be found at www.ic/nhs.uk/canceraudits. For further information about this report, email: [email protected] or contact: National Clinical Audit Support Programme (NCASP) The Information Centre for health and social care 1 Trevelyan Square Boar Lane Leeds LS1 6AE Copyright © 2008, The Health and Social Care Information Centre, National Head and Neck Cancer Audit. All rights reserved. Contents Contents i Acknowledgements i 2.0 Background to head and neck 10 ii Foreword ii cancer and comparative audit 2.1 What is head and neck cancer? 10 2.1.1 Cancer sites 10 2.1.2 Impact of head and neck cancer on 1.0 Executive Summary 1 patients 10 1.1 What is DAHNO? 1 2.1.3 Outcome in head and neck cancer 1.2 What DAHNO adds to existing 1 2.2 Measuring clinical care 10 information 2.3 Key partners and influences in 10 1.3 Where head and neck cancer care 1 cancer audit happens – submission rates 2.3.1 The National Clinical Audit Support 10 1.3.1 Contributing Cancer Networks in 1 Programme (NCASP) and Patient’s England and Wales Outcomes Programme 1.3.2 Overview of case ascertainment and 1 2.3.2 ‘NHS Plan’ in England and ‘Designed to 10 data quality tackle cancer’ in Wales, and cancer audit 1.4 Key overall findings 2 2.3.3 National Institute for Clinical Excellence 11 1.4.1 The pivotal role of the multi disciplinary 2 (NICE) Improving Outcomes Guidance (MDT) meeting (IOG) for head and neck cancer 1.4.2 Multi-professional care in head and 2 3.0 DAHNO application infrastructure 12 neck cancer 3.1 The DAHNO System 12 1.5 Who receives the care? 2 3.2 DAHNO application security and 12 1.5.1 The patient journey – Is care getting 2 patient confidentiality more timely? 3.2.1 DAHNO application security 12 1.5.2 Evidence of improvement/assurance in 3 3.2.2 Patient confidentiality quality of care (increasing the proportion 12 of patients who receive appropriate 4.0 Methods and Approaches 13 specialist opinion and treatment) 4.1 Methodology 13 1.6 Recommendations 3 4.2 Clinical aspects applicable to Phase II 13 1.7 Key aspects for the current collection 4 year November 2008 – October 2009 4.2.1 Inclusions and exclusions in the head 13 and neck cancer audit 1.8 Future direction of the National Head 4 and Neck Cancer Audit and links to the 4.3 Determining cancer centres: Provider 13 National Cancer Intelligence Network Trusts managing head and neck cancer (NCIN) agenda 4.4 DAHNO system improvements rolled 13 1.9 Good Practice 4 out in 2008 1.10 Summary report 4 4.5 Priority outputs and rationale 13 1.11 Participating Trusts 5 4.6 Data standards 13 Copyright © 2008, The Health and Social Care Information Centre, National Head and Neck Cancer Audit. All rights reserved. Contents 5.0 Benefits of participation 14 8.4.1 Larynx 38 6.0 Improvements and 15 8.4.1.1 Stage at diagnosis 38 8.4.1.2 Comparison of stage at diagnosis and 38 Recommendations post-surgery staging 6.1 Case Ascertainment and Data Quality 15 8.4.1.3 Summary of recorded stage certainty 39 6.2 The patient pathway 15 8.4.2 Oral Cavity 39 6.2.1 Patients being seen at the MDT 15 8.4.2.1 Stage at diagnosis 39 6.2.2 Patients having chest imaging by 16 8.4.2.2 Comparison of stage at diagnosis and 40 CXR/CT prior to care plan post-surgery staging 6.3 Issues and recommendations 17 8.4.2.3 Summary of recorded stage certainty 40 7.0 Statistical methods used 20 8.4.3 Oropharynx 41 for data analysis 8.4.3.1 Stage at diagnosis 41 8.0 Findings 21 8.4.3.2 Comparison of stage at diagnosis and 42 post-surgery staging 8.1 Introduction 21 8.4.3.3 Summary of recorded stage certainty 42 8.2 Analysed data 21 8.4.4 Hypopharynx 42 8.2.1 Is data quality improving? 22 8.4.4.1 Stage at diagnosis 42 8.2.2 Which subsites of head and neck 24 cancer have been reported 8.4.4.2 Comparison of low to high stage 42 disease by tumour site 8.3 Where head and neck cancer care 25 happens 8.5 Cumulative submission by Network 45 of patients with new head and 8.3.1 Estimate of total number of patients 25 neck primaries of the larynx and with new head and neck primaries of oral cavity by ratio of low to high the larynx and oral cavity in the index stage disease January 2004 – period by Cancer Network October 2008 8.3.2 Submission by Network and Provider 26 8.5.1 Submission by Network of patients 47 Trust of patients with new head and who underwent surgery of the larynx neck primaries in the index period and oral cavity where recording of pre treatment and post resective 8.3.2.1 Where cancer care happens – has it 30 pathological staging is identified in the changed since the inception of the index period audit? 8.6 Are factors relevant to risk 48 8.3.3 Cancer Networks with consistently 30 adjustment being recorded? high levels of case ascertainment 8.6.1 Distribution of performance status at 48 8.3.4 Submission by Cancer Network and 33 point of treatment decision Provider Trust of patients with new head and neck primaries in the index 8.6.2 Presence or absence of significant 48 period, where cases had pre treatment co-morbidity at index point of diagnosis recorded T and N staging category (ACE-27) 8.4 Distribution of stage 38 8.6.2.1 Summary of recorded co-morbidity 48 Copyright © 2008, The Health and Social Care Information Centre, National Head and Neck Cancer Audit. All rights reserved. Contents 8.6.3 Deprivation analysis: Distribution of 49 8.7.1.7.1 Interval from diagnosis to MDT 67 diagnosis, treatment and outcome by (‘triage’ date) socio-economic Lower Super Output Areas, derived from the postcode in 8.7.1.7.2 Interval from diagnosis to date care 70 England and Wales plan agreed 8.6.3.1 Summary of registrations by deprivation 50 8.7.1.8 Number and percentage with 71 in England and Wales histological confirmation prior to cancer careplan 8.6.3.2 Deprivation and stage in England 50 8.7.1.9 Number and percentage with staging 71 8.6.3.3 Deprivation and interval from onset of 51 information recorded at time of cancer first symptom to referral in England careplan 8.6.3.4 Deprivation and interval from referral 8.7.1.10 Percentage having chest imaging 72 to treatment in England by chest x-ray (CXR) or chest computerised tomography (CT) 8.6.3.5 Proportion of registrations in each cancer 52 prior to cancer careplan network in England and Wales by quintile of deprivation January 2004-October 2008 8.7.1.10.1 Percentage with reported chest 73 imaging by chest x-ray (CXR) or chest 8.7 Is care getting more timely? 55 computerised tomography (CT) 8.7.1 The patient journey – diagnostic and 55 prior to MDT staging process, waiting intervals 8.7.1.11 Interval from imaging request to 73 8.7.1.1 Source of referral to specialist team in 55 date imaging performed (CT/MRI) England contributory to pre-treatment staging complying with the Royal College of 8.7.1.1.1 All anatomic sites 55 Radiologists’ guidelines 8.7.1.1.2 Larynx 56 8.7.1.11.1 Imaging types where interval from 74 imaging requests from data imaging is 8.7.1.1.3 Oral cavity – the role of the General 57 performed is four weeks or more Dental Practitioner 8.7.1.12 Interval from diagnosis to first 74 8.7.1.2 Summary as percentage of cases with 57 definitive treatment both ‘primary referral priority’ and ‘primary referral source’ completed in England 8.7.1.12.1 Interval from diagnosis to first 76 definitive treatment by trust and by 8.7.1.2.1 Oral cavity 57 type of treatment 8.7.1.3 Interval from first symptom to referral to 57 8.7.1.13 Interval from referral to first definitive 76 specialist team treatment in England 8.7.1.4 Interval from referral to first 58 8.7.1.14 Interval from surgical resection 77 appointment in England to reporting on resective specimen 8.7.1.5 Interval from referral to diagnosis 59 8.7.1.15 Interval from date of surgery to 78 in England and Wales post-operative radiotherapy 8.7.1.5.1 Time from biopsy to reporting 60 8.8 Evidence of improvement / 79 8.7.1.6 The multi-disciplinary team (MDT) and 63 assurance in quality of care (increasing the proportion of its functions patients who receive appropriate 8.7.1.7 Interval from diagnosis to 67 specialist opinion and treatment) decision to treat Copyright © 2008, The Health and Social Care Information Centre, National Head and Neck Cancer Audit.
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