Transcript Heather Payne - National Prostate Cancer Audit

National Prostate Cancer Audit
Heather Payne, NPCA Oncological Clinical Lead
Consultant Clinical Oncologist, UCL
www.npca.org.uk
[email protected]
Prostate Cancer
• Most common solid cancer in men & second most common
cause of cancer death in UK men, after lung cancer
• 40,000 new cases and 10,000 deaths/year
– 110 men are diagnosed each day (30 deaths/day)
• Variable course in different patients
– High risk = aggressive & fast growing (clinically significant) vs low risk =
localised & slow growing (clinically insignificant disease)
Cancer Research UK. Prostate cancer statistics, 2014
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Prostate Cancer
Disease Staging
(MDT) Multi-disciplinary
Team Guidance for
Managing Prostate
Cancer
• British Association of Urological
Surgeons (BAUS) Section of
Oncology
• British Uro-oncology Group
(BUG)
• British Prostate Group (BPG)
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Prostate Cancer (2)
• An increasing number of men are living with a diagnosis of
low-risk localised disease without evidence of spread beyond
the prostate
– A key concern is the potential for patients with low-risk disease to
undergo radical treatments
• Men with high-risk localised or locally advanced disease are
more likely to develop progression and to die of their disease
– May not be getting the radical treatments (multimodal therapy) that
they need
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* High-risk localised prostate cancer is also included by NICE for the same therapy options as locally advanced prostate cancer
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Background
• Healthcare Quality Improvement Partnership (HQIP)
established in 2008 to promote quality in healthcare
– Increase the impact of clinical audit on healthcare quality
• HQIP set up the National Clinical Audit and Patient Outcomes
Programme (NCAPOP)
– Commissions large scale audits
• Acute, Cardiac, Long-term conditions, Mental health, Older people,
Women & Children
• Cancer – bowel, head & neck, oesophogastric, lung
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National Prostate Cancer Audit (NPCA)
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Commissioned by HQIP as part of the NCAPOP programme
Contract awarded to the Clinical Effectiveness Unit, RCS
Managed as partnership with BAUS, BUG and NCRS
Audit initiated in April 2013, minimum of 5 years
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Governance Structure
• Project Team: undertake all activities required to
deliver the audit (based in CEU of RCS)
• Project Board: oversee the delivery of the contract
• Clinical Reference Group: support implementation of
the audit
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Clinical Reference Group
• Same Chair as NCIN Urology Site-specific CRG (Roger
Kockelbergh) -> avoid overlap and ensure cross
fertilisation
• Members from
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BAUS
BUG
BAUN
RCGP
Patient and public reps (Prostate Cancer UK, Tackle Prostate Cancer)
NCIN
National Peer Review
National Commissioning Board
Specialised Urology CRG, NHS England
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National Prostate Cancer Audit
• Aim:
– assess the process of care and outcomes in men diagnosed with
prostate cancer in England and Wales
• Key audit topics:
– service delivery and organisation of care
– characteristics of newly-diagnosed prostate cancer, how the cancer was
detected and the referral pathway
– diagnostic and staging process
– planning of initial treatment & treatments received
– patient experience and health outcomes 18 months after diagnosis
– overall and disease-free survival
– feasibility of a PSA testing audit in primary care
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Audit Topics and Objectives
• Audit Topics
– For each trust we will describe:
• Presenting stage and risk stratification
• Prostate cancer treatments received
• Patient experience and quality of life 18 months after radical
prostate cancer therapy
• Audit Objectives
– Report
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Use of active surveillance for men with low risk prostate cancer
Use of appropriate radical therapy for high risk prostate cancer
Outcomes following radical treatments
Use of PSA testing
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Key Objectives: Year 1
• Carry out an organisational audit of prostate cancer care in
England and Wales
• Analyse existing data to provide comparative background data
for the audit
• Design a national data collection system and a short and
simple minimum dataset for the prospective audit
• Scoping of feasibility study for audit of PSA testing in primary
care
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Published on the 10th
November 2014
Available for download
from our website
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Key Objectives: From Year 2
• Collect prospective data from each newly-diagnosed patient
discussed at a MDT meeting
• Initiate data collection in April 2014 and will continue
throughout the audit
• Data collection started in England in April
• Data collection in Wales delayed until April 2015
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Key Objectives: From Year 3
• Collect PROMs and PREMs from all patients with localised
prostate cancer who are candidates for radical treatment 18
months after diagnosis
• Data collection will start in October 2015 and will continue
throughout the audit
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What improvements are anticipated?
• Appropriate use of active surveillance for men with low risk prostate
cancer based on patient choice
• Appropriate use of multimodality for men with high risk or locally
advanced prostate cancer
• Improved safety and toxicity profile of prostate cancer therapy
• Reduced variation in prostate cancer therapy across NHS trusts
• Findings from the feasibility study of PSA testing will guide the planning of
a national approach for the diagnosis of prostate cancer in line with men’s
preferences
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Thank you!
The success of the NPCA is
dependent on your continuing
support
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‘A national clinical audit of prostate cancer care will
improve clinical practice and patient outcomes, and
ultimately save lives. The success of this audit has our
full support and commitment.’
− Adrian Joyce, President of BAUS (until June 2014)
‘BUG supports NPCA as it is a fantastic opportunity to
provide accurate data directly from MDTs with minimal
administrative burden on staff and patients alike. This
will improve the quality of care and outcome of
patients nationwide.’
− Simon Russell, Secretary of BUG
www.npca.org.uk
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