Transcript National Oesophago-Gastric Cancer Audit

National
Oesophago–Gastric Cancer
Audit
Comparing local and national figures
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This slide set is designed to help you audit your
local trust practice against other Trusts in your
SCN and vs National figures where appropriate.
We have designed the slides so you just enter
your data available from the Annexes in the
appropriate space.
Information for HGD cases from Progress Report
Annexes.
Data submitted to NOGCA
National
Local Trust
Cases recorded
22,832
xx
% case ascertainment
78.6%
xx
% NOGCA successfully linked
with RTDS
90.6%
xx
465
xx
OG cancer
HGD Oesophagus
Cases recorded
Data completeness – Surgical
records
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For surgical cases the NOGCA reviewed the
completeness of records submitted to the audit.
◦ Including the use of ‘unknown’ for mandatory variables.
Local Trust
Number of surgical cases
Surgical intent recorded (%)
Complications recorded (%)
Death in hospital recorded (%)
Matched pathology record (%)
Data completeness – Pathology
records
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Staging data is key in risk adjusting cases for
monitoring surgical outcomes. Including the use
of ‘unknown’ for mandatory variables.
Local Trust
T-stage recorded (%)
N-stage recorded (%)
M-stage recorded (%)
Surgical Outcomes
National
Local Trust
4,898
xx
30-day
2.4%
xx
90-day
4.4%
xx
Complication rate
27.7%
xx
Curative Surgery volume
Mortality rate
On this slide you can compare your trusts mortality to national
figures and highlight your own trust on the graph
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Quality of surgery indicators
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With falling mortality associated with OG cancer
surgery, focus needs to go towards monitoring
quality of surgery.
◦ Adequate lymph node resection is needed for staging,
and to increase the chance surgery is curative.
◦ Aim of surgery should be to achieve tumour free
resection margins, otherwise patient is rarely =cured.
National
Positive resection margin (%)*
26.7%
Adequate lymph node resection (%)
89.2%
Length of stay, median (days)
12
Local Trust
* Where both longitudinal and circumferential margin status known. 26.6%
of patients did not have data recorded for both margins.
** >6 lymph nodes for oesophagectomy, >15 lymph nodes for gastrectomy
Surgery with adjunct oncology
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BSG guidelines
◦ Oesophageal cancer - Preoperative chemoradiation improves longterm survival over surgery alone.
◦ Gastric cancer - Perioperative combination chemotherapy conveys a
significant survival benefit and is a standard of care.
Proportion of
patients with locally
advanced disease
managed surgically
who received
additional
On this slide you can highlight your SCNs adherence to BSGoncological therapy.
guidelines for use combination surgery and oncological treatment
of OG cancer
DELETE
THIS
BOXJ, Griffin S, Cunningham D, Jankowski J, Wong R. Guidelines for
 Allum W,
Blazeby
the management of oesophageal and gastric cancer. Gut. 2011;60(11):1449-72.
OG cancer in elderly
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58.9% OG cancers diagnosed in patients aged 70yrs
or over.
Planned treatment intent (unadjusted)
◦ Age <70:
49.4% curative
◦ Age ≥ 70:
28.9% curative
Variation in proportion of patients over 70 managed
with curative intent across SCNs.
On this slide you can highlight the proportion of elderly patients
managed with curative intent in your SCN.
If low consider whether steps need to be taken to ensure
decisions regarding treatment intent based on disease extent and
patients factors e.g. co-morbidities, irrespective of age of patient.
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Early Cancers
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5.4% OG cancers diagnosed at early stage
(T0/1,N0,M0).
Across SCNs significant variation in proportion of
cancers diagnosed early.
On this slide you can highlight the proportion of patients diagnosed at an
early stage in your SCN.
If low consider whether steps need to be taken to try and increase this figure
in future e.g. targeting improving patient and GP awareness, ensuring easy
access to endoscopy.
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Contact Details
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For any queries please contact:
Dr Georgina Chadwick
Clinical Research Fellow
The National Oesophago-Gastric Cancer Audit
E-Mail: [email protected]