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Our Partnership

A partnership between the National Cancer Registration and Analysis Service (NCRAS) and Transforming Cancer Services Team (TCST) was established in 2015. The partnership recognised that an investment in cancer analytics would enable commissioners and providers to accelerate improvements in cancer services and data across London. There are significant additional analyses that both parties have been interested in taking forward, but neither organisation has been able to progress for various reasons (including analytical capacity and access to data). Therefore the recruitment of three new cancer analysts to work jointly between NCRAS and TCST was agreed.

The availability of local analyses of nationally collated data will provide the opportunity to drive improvement in outcomes in London, both in quality of patient care and efficiency. Providing these analyses is the core focus of this partnership.

There is an established working relationship between NCRAS and TCST, through the collaboration on the NCRAS London work programme. This is currently managed by the NCRAS Senior Analyst, and is in collaboration with UCLH Cancer Collaborative, RM Partners, and south-east London, and this will continue.

Our Priorities

NCRAS and TCST will agree strategic priorities and new areas of work in the context of the wider NCRAS and TCST work programmes, and the external environment. These should consider the wider London landscape, including the Vanguards and Integrated Cancer Systems.

The partnership aims to carry out analyses which will deliver a high quality, London-wide cancer analytical resource. The deliverables will fall into two categories: novel and derivative work. Novel work will evolve as the partnership develops, but the analysts will need to have close links to the clinical context through the pathway boards in the Integrated Cancer Systems, as well as to commissioners. Derivative work would be based on existing national reports but broken down into a more useful population / geography scale for London.

Our Progress

December 2017:Segmented analysis of prostate cancer pathway from referral to treatment: 2013-2015 is published. This work is currently being replicated for colorectal and lung cancers.

December 2017:A workbook on Cancer Prevalence in England: 21 year prevalence by demographic and geographic measures is published.

October 2017: Understanding the current cancer population in England: detailed prevalence estimates is presented at the International Association of Cancer Registries conference in Utrecht, The Netherlands.

September 2017: Practice Profiles Plus, Association of prevalence and comorbidities at diagnosis for those living with cancer in London, and Prevalence of subsequent primary tumours wit demographic variation for those living with cancer in London are presented as posters at the PHE annual conference.

June 2017: A workbook on comorbidity at diagnosis for those living with cancer in London is published. This work is presented at the PHE Cancer Data and Outcomes Conference in the same month.

April 2017: Practice Profiles Plus refreshed to include 15/16 data.

February 2017: Practice Profiles Plus is presented as an oral presentation at the Cancer Research UK Early Diagnosis Conference.

January 2017: The workbook on repeat diagnostics for lung cancer in London is published.

July 2016: Practice Profiles Plus to be launched and circulated to stakeholders, GP facilitators and GPs.

June 2016: maps of London created showing the variation of stage at diagnosis and ethnicity by CCG for 2012–2014 which will be delivered to commissioners.

May 2016: start of the project researching the lung cancer diagnostic pathway in London. The aim of the project is to map the diagnostic pathway for those with lung cancer in London, and to develop a measure identifying multiple diagnostics within the pathway.

May 2016: start of the London Older Persons report based on the previous Older People and Cancer report published at a national level (NCIN , 2015). The aim of the project is to highlight areas of variation in access and care in older persons in London.

April 2016: start of project to create an automated version of Practice Profiles Plus to be circulated to CCGs and GP facilitators, and any interested stakeholders.

April 2016: recruitment of three analysts to begin work on the partnership priorities.

Our Publications

Segmented analysis of prostate cancer pathway from referral to treatment: 2013-2015: this project assesses the typical pathway for those diagnosed with prostate cancer in London in the aim to understand the pathway better as this is a pathway that is typically challenged in terms of meeting the 62 day cancer waits standard.

The pathway is presented by the median time taken between when a patient is referred to when they are first seen in secondary care, from when they are seen in secondary care to diagnosis, from diagnosis to the patient’s first MDT meeting, and from the MDT meeting to the treatment start date.

The pathway is further segmented by year of diagnosis (2013-2015), stage at diagnosis, age at diagnosis, ethnicity, resident CCG and STP, and diagnosis trust.

This work is currently being replicated for lung  and colorectal cancers and will be published in February 2018.

Comorbidity at diagnosis for those living with cancer in London: Comorbidity at diagnosis may impact the effectiveness and delivery of cancer treatment, survival outcomes and quality of life of cancer patients. This study explores the variation in serious comorbidity at the time of cancer diagnosis in people living in London.

This workbook presents data on twenty year prevalence by Charlson comorbidity index score and stratified by geography, sex, socio-economic deprivation, tumour site, age, and years since diagnosis. This work provides valuable new intelligence in understanding differing demographics and needs of patients with various levels of comorbidity.

Repeat Diagnostics for Lung Cancer in London:This project investigated whether repeat diagnostic imaging during the patient pathway is occurring by making use of the existing Diagnostic Imaging Dataset (DID). Lung cancers (C33 and C34) diagnosed in London and West Essex during 2013 and 2014 recorded in the National Cancer Registry were linked to DID records. Repeat diagnostics may be indicative of either a complex diagnosis in the patient, which should be relatively rare, or an inefficient pathway. The latter would not represent the best experience for the patient or use of diagnostic capacity and resources.

Descriptive data is provided on the volume of imaging, referral source, sex, median age, stage at diagnosis, and time delay between imaging procedure and diagnosis. This data is segmented by the number of diagnostic images, clinical commissioning group, strategic transformation plan, year, and imaging modality.

Pathway analysis was carried out, segmented by imaging modality and year, to evaluate patterns by London trust on where preceding and subsequent images were being carried out, and to assess the patterns in repeating imaging by referral pathway.

Following a meeting to discuss the findings of the work with the lung cancer lead for NCRAS, we would like to highlight the following points for consideration when reviewing the results:- Repeat procedures may be requested if the previous image was carried out more than a month prior, to assess for change before making the treatment decision- Repeat chest CT scans are often requested if the previous chest CT image is not of high quality or if the previous image was not a contrast enhanced chest CT scan- Future analytical work investigating the proportion of repeat images where the repeat image carried out was a contrast chest CT scan, and the preceding image was a plain chest CT scan as an explanation as to why repeat chest CT scans may occur is being considered.

This work was carried out in collaboration with Cancer Research UK.

Maps of all sites, breast, colorectal, lung and prostate cancer diagnosis by stage and ethnicity in London, 2012 – 2014:  Heat maps have been created to show the presentation of all sites, breast, colorectal, lung and prostate cancers by ethnicity and stage for the 32 CCGs in London and West Essex CCG, 2012–2014. For ethnicity presentation at cancer diagnosis, all sites were segmented into those of Asian, black, white, other, and unknown ethnicity. For stage at cancer diagnosis, all cancer sites were presented as stage I, II, III, and IV whilst for breast, colorectal, lung, and prostate cancers stage were presented as early (stage I and II), advanced (stage III and IV), and unknown stage. For both ethnicity and stage data quality appears to improve over the time period.

Practice Profiles Plus: This profile provides a summary of the key diagnosis and referral indicators for your practice or CCG with regards to cancer. The profile enables comparisons to be made with other practices within a CCG, as well as with regional and national figures, to allow for benchmarking and to highlight variations. Each indicator is accompanied by a description of key contextual or influencing factors and provides information on local and/or national resources and initiatives which practices can draw on to help improve cancer outcomes. The profiles have been refreshed to include data for the 15/16 financial year.For raw data methodology and further indicator definitions and methodology, see source website: http:/fingertips.phe.org.uk/profile/cancerservices.

The purpose of the profile is to help practices reflect on their clinical practice and cancer service delivery, with a particular focus on symptom recognition and early diagnosis. It is not intended to be a measurement of performance. However, you may wish to review indicators which are significant outliers for your profile. As many indicators are influenced by factors such as age and deprivation, practices should review this profile in conjunction with their demographic characteristics. This profile presents crude rates which are not adjusted for demographic factors. However, PP+ also provides a practice index including additional demographic data to help provide context.A graph is provided for each indicator to visualise individual practices and how they are performing compared to the CCG, London and England averages. Significance compared to the CCG average is also being shown with colour coding. CCGs can also be visualised comparing how they are preforming to the London and England averages. Significance compared to the London average being shown by colour coding. There are five years of historic data available for each indicator as historical data may wish to be reviewed to assess data trends for each indicator over time. Whilst the data in this tool is presented at the CCG level, individual practices may find it useful to visit the source website to see their individual practice data concisely presented.For further information regarding population size of each practice, and additional variables, for the most recent year please visit http://fingertips.phe.org.uk/profile/general-practice/data. For a copy of the full interactive workbook please contact: lucy.young at phe dot gov.uk link Lucy.young@phe.gov.uk

Practice Profiles Plus

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Cancer bed use analysis across London Trusts: A large project has been undertaken on the bed usage for cancer patients across London trusts.  There are a number of reasons that commissioners and providers need to understand this, with the aim of understanding variation and progress over time.  The reasons include:

- Reducing the length of elective surgical admissions and associated readmissions, including, in some instances, moving to day-case surgery to make services more cost effective against tariff and also to release provider capacity.

- Reducing the number and length of elective medical admissions, particularly those under haematologists or medical/clinical oncologists.  In some instances this may mean avoiding inpatient admissions altogether by providing care in ambulatory settings.

- Reducing the number of emergency admissions due to side effects of treatment (such as chemotherapy or radiotherapy) or progressive disease. The aim is that, with more proactive management of patients’ symptoms and side effects, and with better patient education, problems can be identified early and managed on an ambulatory basis and emergency admissions avoided.  

Findings from this project will be delivered in multiple outputs:

1) Admissions:  This workbook shows data on inpatient bed use by cancer patients in London and West Essex, showing the overall number of admissions and the length of stay with a breakdown by tumour type, CCG and provider.

2) Specialty:  This workbook shows data on inpatient bed use by cancer patients in London and West Essex, showing the overall number of admissions and the length of stay with a breakdown by specialty, CCG and provider.

For further TCST resources please see the MyHealthLondon website.

Local Intelligence

Local Cancer Intelligence

Region specific work

East of England

London

 NCRAS - TCST Partnership