Transcript www.nescn.nhs.uk

Northern Oesophago Gastric Cancer Unit MDT data
NECN Audit Meeting – 6th November 2013
Methods
• Patients discussed at weekly Newcastle Multi-disciplinary
Team meeting in period January – December 2012
• Excludes patients discussed by video-link to Sunderland
• Prospective data entry onto database - Dendrite
• Intended use:
Local, Regional & National audit
Research
• Data then exported onto Microsoft Excel for analysis
National Audit Programme
The second Audit began collecting prospective data
on patients (aged 18 years or over) diagnosed with
invasive epithelial cancer of the oesophagus, gastrooesophageal junction (GOJ) or stomach on or after 1
April 2011.
Since 1 April 2012, the Audit has also included
patients diagnosed with oesophageal high-grade
glandular dysplasia (HGD). To allow this, a slightly
revised dataset was implemented in April 2012.
National Audit 2013 – Resections by site
No of cases
Derby
Barking
Portsmouth
Guildford
Marsden
Barts
Norwich
Coventry
Leeds
Southampton
Middlesbrough
Sheffield
Birmingham
Oxford
Leicester
Cambridge
Bristol
Plymouth
Nottingham
Salford
Newcastle upon Tyne
0
50
100
150
MDT Discussions
0%
Total
20%
40%
674
60%
80%
100%
837
588 excl Carlisle
New
722 excl Carlisle
Rediscussions
n=1511
incl Carlisle
New discussions
Other incl. – GISTs, HGD, LGD,
Surveillance pts, &
referred onto another MDT
N = 674
538 + cancers
New OG neoplasm
0%
Total
20%
40%
60%
303
New Staging
80%
91
In-Patients
100%
69
Restage
n=463
Number of MDT Discussions
300
264
250
200
150
119
91
100
63
35
50
8
0
8
No. of Discussions
1
2
3
4
5
6
>6
Median discussion: 2
N=588 – New Discussions
Excl. 86 Carlisle pts
Age
Positive cancers only discussed at MDT Jan-Dec 2012
Age range
Male
Female
<=30
0
0
<=40
3
4
<=50
12
8
<=60
54
26
<=70
104
48
<=80
115
62
<=90
55
37
90+
4
6
TOTAL
347
191
Carlisle Discussions
New referrals to MDT by site
0
50
100
150
200
Newcastle
Northumb'd
Sunderland
Durham
S. Tyneside
Gateshead
Others
Unclass'd
2012
2011
2010
2009
n=450 vs. 324 vs. 408 vs 467 vs 437 vs 463
excl Carlisle pts – positive cancers only
Intention to treat by site - 2012
Total
Sunderland
South Tyneside
Gateshead
NUTH
Northumberland
Durham
0%
Friday MDT’s only
10%
20%
30%
40%
Curative
50%
Palliative
60%
70%
No action
80%
90%
100%
No action – incl. Benign,
Best supportive care &
referral onto other MDT’s
Oesophageal Cancer:
(2012) Histological subtype
Histology
0%
10%
20%
30%
ACA
40%
50%
60%
SCC
Small Cell
HGD
70%
80%
90%
Other
Other incl. – Carcinoid,
Leioyoma, melanoma,
benign
100%
Oesophageal Cancer: Treatment intent
by histological subtype
SCC
ACA
0%
10%
20%
30%
40%
Curative
50%
60%
Palliative
70%
80%
90%
100%
Oesophageal cancer: Curative treatment
intent
0
10
20
ACA
SCC
30
40
50
47
8
5
3
60
22
5
Other 0
NA+Sx
Sx Alone
RT
CRT
R & Sx
70
4
80
Actual Resections - Pos Cancers only
Procedures 2012
Completed
Incompl.
30 day
90 day
Comps 3+
Accordion
Oesophagectomy
83
4
0
3
25
Total Gastrectomy
35
3
1
3
5
Subtotal
Gastrectomy
50
2
0
0
7
Lesser resection
13
0
0
0
2
EMR
35
N/A
0
0
0
Morbidity/Complications
note: 30 day Mort
all complications incl.
0%
40%
20%
2009
2010
60%
80%
33
65
42
58
100%
2
2
n=137 - 2009
n=149 - 2010
2011
55
45
2012
55
44.5
No Complications
All Complications
Mortality
0
n=162 - 2011
N=168 - 2012
0.5
Pathological Stage by subtype
35
30
Excl. Carcinoid’s &
Leioyoma’s excluded, 8
open and close excluded
25
20
SCC
ACA
15
10
5
0
Tis
T0N1
T1N0
T1N1
T1N2
T2N0
T2N1
T3N0
T3N1
T3N2
T2N2
T4N0
T3N3
T4N0
T4N1
T4N2
T4N3
Oesophageal Cancer: Treatment change
Intended Treatment
Treatment Change
n
Neoadjuvant + Surgery
Unfit for surgery
3
Neoadjuvant + Surgery
Progression of disease, no surgery
7
Neoadjuvant + Surgery
RIP (1 cycle)
2
Neoadjuvant + Surgery
Patient declined
2
Surgery
Not fit for surgery/patient declined
2
Neoadjuvant + Surgery
Shortened chemotherapy due to toxicity
5
Neoadjuvant + Surgery
No neoadjuvant given
2
Chemoradiotherapy
Toxicity 1 pt did not complete chemo, although did
complete radio.
1
Recruitment to trials - 2012
100%
90%
80%
70%
16
6
60%
Fail
50%
Recruited
40%
30%
20%
16
2
10%
0%
ST03
COUGAR-02
Please note: Cougar 02 closed
30/04/12. Other trials had closed
UGI Two Week Waits 2012
200
180
160
140
120
100
80
60
40
20
0
2ww
31 day treats
62 day treats
62 day breaches
62 day breaches: 14.5 (0.84%)
Refs- 2 Week Waits – Comparison by Year
2008
20002009
2010
2011
1800
2012
2WW
1150
1325
1488
1489
1720
1600
1400
1200
1000
800
600
400
200
0
2008
2009
2010
2011
2012
Breaches - Comparison
35
30.5
30
25
23
20
16
15
14.5
12
10
5
0
2008
2009
2010
2011
2012
Acknowledgements
Helen Jaretzke
Angie Tate
Paula Brooks
Jonathan Stoddart
NOGCU Data Manager
NOGCU Data Clerk
MDT Coordinator
NCCC Research Coordinator