Transcript NHS Forth Valley Palliative Care Strategy 2006

Men’s Health and Cancer
4th December 2009
Dr Paul Baughan
GP, Dollar Health Centre, Clackmannanshire
Clinical Lead, WoSCAN Primary Care Group
Men’s health and cancer
1. Cancer in Scotland today
2. Role of West of Scotland Cancer Network
(WoSCAN)
3. Specific projects relating to Men’s Health
and cancer within WoSCAN
Lifetime risk of cancer in
Scotland
1 in 3 men in Scotland will develop some form
of cancer during their lifetime.
For males, the lifetime risk of developing:
- lung cancer is estimated as 1 in 13
- prostate cancer is 1 in 13
- colorectal cancer is 1 in 18 men
Figure 1: Ten most commonly diagnosed cancers in males, 2006
Other
20.4%
Trachea, bronchus and lung
19.2%
Kidney
3.2%
Non-Hodgkin's lymphoma
3.3%
Malignant melanoma of skin
3.4%
Prostate
19.2%
Bladder
3.6%
Stomach
3.7%
Oesophagus
4.0%
Head and Neck
5.8%
Colorectal
14.1%
Figure 5:Scotland:
Number of registrations
age-specific
rates per
100,000,
malignant
neoplasm's
diagnosed
in 2006, by
Numberand
of new
cancers
and
rate all
per
100 000
by gender
in 2006
sex
2,500
4,000
3,500
2,000
3,000
Males: numbers
Females: numbers
2,500
Females: rates
2,000
1,000
1,500
1,000
500
500
0
0
Under 5
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
Age at diagnosis
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Rate per 100, 000
Number of registrations
Males: rates
1,500
Survival from cancer in
Scotland
Survival is worst in patients with cancers that often present at an
advanced stage and are less amenable to treatment (for example,
cancers of the lung and pancreas).
Survival tends to be better for:
- cancers for which patients present at an early stage (for
example, malignant melanoma of the skin),
- cancers which can be detected early by screening (for
example, breast cancer)
- cancers for which there have been major advances in
treatment (for example, testicular cancer and leukaemias).
Survival from cancer in
Scotland
5 Year Survival Rate by Gender
60
51
50
42
% Survival
40
38
Men
30
Women
26
20
10
0
1984
2004
Year
Prevalence of cancer
Over all ages, 2.2% of men in Scotland are living with cancer
The prevalence of cancer in the Scottish population increases with
age, with 10% of men aged 65 and over living with cancer
Cancer in men in Scotland
• Incidence is higher
• Survival rates are lower
• Prevalence is higher
Men’s health and cancer
1. Cancer in Scotland today
2. Role of West of Scotland Cancer
Network (WoSCAN)
3. Specific projects relating to Men’s Health
and cancer within WoSCAN
What is a network?
‘An extended group of people with similar
interests or concerns who interact and
remain in informal contact for mutual
assistance or support’
What is a managed
clinical network?
"linked groups of health professionals and
organisations from primary, secondary
and tertiary care, working in a coordinated manner, unconstrained by
existing professional and Health Board
boundaries, to ensure equitable provision
of high quality clinically effective services
throughout Scotland".
West of Scotland Cancer Network (WoSCAN)
Organisational Char t, West of Scotland Can ce r Ne twork
NHS QIS
NHS Areas , Loc al
Canc er &
Palliativ e Care
Groups /
Networks
Royal College s
Regional
Managed Clinic al
Networks
Centre for Chang e
& Innovation
National
Managed
Clinic al
Networks
Formalis ed
Regional
Networks
Breas t
Ay rs hire &
Arran
Forth Valley
Greater
Glas gow &
Cly de
Colorec tal
Hepatobiliary
MCN
Gy naecology
Sk in
Lung
Lanarks hire
Nurs ing
Pharmac y
Bone & Soft
Tis s ue
Sarc oma
MCN
Neuro oncology
Primary
Care
Pres c ribing
Adv is ory
Group
Cepas
Projec t Board
Head & Nec k
Wes t of Sc otland Population
Patient
Partners hip
Forum
Waiting Times
Upper GI
Haematoonc ology
Chemotherapy
Strategic
Rev iew
Implementation
Group
Spec ialis t
Onc ology
Strategic
Rev iew
Group
Urology
SIGN
Sub-Groups
SCRN
Palliativ e Care
Dumfries &
Galloway
Wes tern Is les
(Uis t)
SEHD
Regional
Canc er
Clinic al
Leads
Group
National
Serv ic es
Regional
Planning
Group
RCAG
Sc ottis h
Canc er
Tas k force
Regional
Serv ic es
Paediatric s
BMT
Genetic s
Opthalmic
Sc reening
West of Scotland C ance r Ne twork
Loc al Authorities
Univ ers ities
Voluntary Organis ations
West of Scotland Cancer Network
Organisational Char t, West of Scotland Can ce r Ne twork
NHS QIS
NHS Areas , Loc al
Canc er &
Palliativ e Care
Groups /
Networks
Royal College s
Regional
Managed Clinic al
Networks
Centre for Chang e
& Innovation
National
Managed
Clinic al
Networks
Formalis ed
Regional
Networks
Breas t
Ay rs hire &
Arran
Forth Valley
Greater
Glas gow &
Cly de
Colorec tal
Hepatobiliary
MCN
Gy naecology
Sk in
Lung
Lanarks hire
Nurs ing
Pharmac y
Bone & Soft
Tis s ue
Sarc oma
MCN
Neuro oncology
Primary
Care
Pres c ribing
Adv is ory
Group
Cepas
Projec t Board
Head & Nec k
Wes t of Sc otland Population
Patient
Partners hip
Forum
Waiting Times
Upper GI
Haematoonc ology
Chemotherapy
Strategic
Rev iew
Implementation
Group
Spec ialis t
Onc ology
Strategic
Rev iew
Group
Urology
SIGN
Sub-Groups
SCRN
Palliativ e Care
Dumfries &
Galloway
Wes tern Is les
(Uis t)
SEHD
Regional
Canc er
Clinic al
Leads
Group
National
Serv ic es
Regional
Planning
Group
RCAG
Sc ottis h
Canc er
Tas k force
Regional
Serv ic es
Paediatric s
BMT
Genetic s
Opthalmic
Sc reening
West of Scotland C ance r Ne twork
Loc al Authorities
Univ ers ities
Voluntary Organis ations
West of Scotland Cancer Network
Organisational Char t, West of Scotland Can ce r Ne twork
NHS QIS
NHS Areas , Loc al
Canc er &
Palliativ e Care
Groups /
Networks
Royal College s
Regional
Managed Clinic al
Networks
Centre for Chang e
& Innovation
National
Managed
Clinic al
Networks
Formalis ed
Regional
Networks
Breas t
Ay rs hire &
Arran
Forth Valley
Greater
Glas gow &
Cly de
Colorec tal
Hepatobiliary
MCN
Gy naecology
Sk in
Lung
Lanarks hire
Nurs ing
Pharmac y
Bone & Soft
Tis s ue
Sarc oma
MCN
Neuro oncology
Primary
Care
Pres c ribing
Adv is ory
Group
Cepas
Projec t Board
Head & Nec k
Wes t of Sc otland Population
Patient
Partners hip
Forum
Waiting Times
Upper GI
Haematoonc ology
Chemotherapy
Strategic
Rev iew
Implementation
Group
Spec ialis t
Onc ology
Strategic
Rev iew
Group
Urology
SIGN
Sub-Groups
SCRN
Palliativ e Care
Dumfries &
Galloway
Wes tern Is les
(Uis t)
SEHD
Regional
Canc er
Clinic al
Leads
Group
National
Serv ic es
Regional
Planning
Group
RCAG
Sc ottis h
Canc er
Tas k force
Regional
Serv ic es
Paediatric s
BMT
Genetic s
Opthalmic
Sc reening
West of Scotland C ance r Ne twork
Loc al Authorities
Univ ers ities
Voluntary Organis ations
West of Scotland Cancer Network
Organisational Char t, West of Scotland Can ce r Ne twork
NHS QIS
NHS Areas , Loc al
Canc er &
Palliativ e Care
Groups /
Networks
Royal College s
Regional
Managed Clinic al
Networks
Centre for Chang e
& Innovation
National
Managed
Clinic al
Networks
Formalis ed
Regional
Networks
Breas t
Ay rs hire &
Arran
Forth Valley
Greater
Glas gow &
Cly de
Colorec tal
Hepatobiliary
MCN
Gy naecology
Sk in
Lung
Lanarks hire
Nurs ing
Pharmac y
Bone & Soft
Tis s ue
Sarc oma
MCN
Neuro oncology
Primary
Care
Pres c ribing
Adv is ory
Group
Cepas
Projec t Board
Head & Nec k
Wes t of Sc otland Population
Patient
Partners hip
Forum
Waiting Times
Upper GI
Haematoonc ology
Chemotherapy
Strategic
Rev iew
Implementation
Group
Spec ialis t
Onc ology
Strategic
Rev iew
Group
Urology
SIGN
Sub-Groups
SCRN
Palliativ e Care
Dumfries &
Galloway
Wes tern Is les
(Uis t)
SEHD
Regional
Canc er
Clinic al
Leads
Group
National
Serv ic es
Regional
Planning
Group
RCAG
Sc ottis h
Canc er
Tas k force
Regional
Serv ic es
Paediatric s
BMT
Genetic s
Opthalmic
Sc reening
West of Scotland C ance r Ne twork
Loc al Authorities
Univ ers ities
Voluntary Organis ations
West of Scotland Cancer Network
Organisational Char t, West of Scotland Can ce r Ne twork
NHS QIS
NHS Areas , Loc al
Canc er &
Palliativ e Care
Groups /
Networks
Royal College s
Regional
Managed Clinic al
Networks
Centre for Chang e
& Innovation
National
Managed
Clinic al
Networks
Formalis ed
Regional
Networks
Breas t
Ay rs hire &
Arran
Forth Valley
Greater
Glas gow &
Cly de
Colorec tal
Hepatobiliary
MCN
Gy naecology
Sk in
Lung
Lanarks hire
Nurs ing
Pharmac y
Bone & Soft
Tis s ue
Sarc oma
MCN
Neuro oncology
Primary
Care
Pres c ribing
Adv is ory
Group
Cepas
Projec t Board
Head & Nec k
Wes t of Sc otland Population
Patient
Partners hip
Forum
Waiting Times
Upper GI
Haematoonc ology
Chemotherapy
Strategic
Rev iew
Implementation
Group
Spec ialis t
Onc ology
Strategic
Rev iew
Group
Urology
SIGN
Sub-Groups
SCRN
Palliativ e Care
Dumfries &
Galloway
Wes tern Is les
(Uis t)
SEHD
Regional
Canc er
Clinic al
Leads
Group
National
Serv ic es
Regional
Planning
Group
RCAG
Sc ottis h
Canc er
Tas k force
Regional
Serv ic es
Paediatric s
BMT
Genetic s
Opthalmic
Sc reening
West of Scotland C ance r Ne twork
Loc al Authorities
Univ ers ities
Voluntary Organis ations
Men’s health and cancer
1. Cancer in Scotland today
2. Role of West of Scotland Cancer Network
(WoSCAN)
3. Specific projects relating to Men’s
Health and cancer within WoSCAN
Specific projects relating to
Men’s Health and cancer within
WoSCAN
1.
2.
3.
4.
Bowel screening
Early presentation of men with cancer
Referral to secondary care
Complications of cancer
Bowel Screening programme
- Women AND MEN aged 50-74
- Started Ayrshire and Arran Sept 07
- Greater Glasgow and Clyde April 09
Bowel Screening programme
Colorectal screening uptake in
Clackmannanshire 08-09
Uptake in colorectal screening programme 2008-09
70
60
% uptake
50
Men
40
Women
30
20
10
0
Falkirk
Stirling
Clackmannanshire
Number invited: 12 682 women, 11 905 men
- Gathering
opinion and experiences from general
population about bowel screening programme,
including the helpfulness of patient literature and
ways to improve uptake.
Specific projects relating to
Men’s Health and cancer within
WoSCAN
1.
2.
3.
4.
Bowel screening
Early presentation of men with cancer
Referral to secondary care
Complications of cancer
The ‘Patient Pathway?’
<62 days for 95% of urgent
referrals
Urgent GP
Referral
Assessment
And
Diagnosis
MDT
meeting
Commence
Treatment
Patient
notices
symptoms
The real ‘Patient
Pathway’
Patient
reports
symptoms
?
GP decides
to refer
<62 days for 95% of urgent
referrals
Urgent GP
Referral
Assessment
And
Diagnosis
MDT
meeting
Commence
Treatment
Early diagnosis audit of cancer
•
•
•
GPs asked to review notes of every patient
diagnosed with cancer during 2007
Note when patient initially spotted symptoms,
when they first reported them to GP or nurse
and when they were referred to secondary
care
Comment on ways to improve the pathway
Distribution of tumour type
2000
1500
1000
500
0
Unknown Primary
Upper GI
81% GP practices took part. 10 286 cancers identified
Prostate
Tumour group
Ovarian
Other urological
Other
Melanoma
Lymphoma
Lung
Leukaemia
Head & Neck
Colorectal
Cervical
Breast
Bladder
number of tumours diagnosed
All Participating Boards
Time from symptoms to
presentation
Median time from symptoms to first presentation
by diagnosis and inter-quartile range
All Participating boards
Bladder
Breast
Cervical
Colorectal
Head & Neck
Diagnosis
Leukaemia
Median time
Lung
Lymphoma
Melanoma
Other
Other urological
Ovarian
Prostate
UGI
Unknow n Primary
0
10
20
30
40
50
60
Median time (days)
70
80
90
100
Time from presentation to
referral
Median time from first presentation to referral
by diagnosis and inter-quartile range
All participating boards
Bladder
Breast
Cervical
Colorectal
Head & Neck
Leukaemia
Diagnosis
Median time
Lung
Lymphoma
Melanoma
Other
Other urological
Ovarian
Prostate
UGI
Unknow n Primary
0
5
10
15
Median time (days)
20
25
Gender differences
Median time from symptoms to first presentation
- by gender and diagnosis
Bladder
Male
Female
Diagnosis
Colorectal
Lung
Melanoma
Upper GI
0
10
20
30
40
50
60
Median time (days)
70
80
90
100
Median time from first presentation to referral
- by diagnosis group and gender
Bladder
Female
Male
Diagnosis
Colorectal
Lung
Melanoma
Upper GI
0
5
10
15
20
Median time (days)
25
30
35
Specific projects relating to
Men’s Health and cancer within
WoSCAN
1.
2.
3.
4.
Bowel screening
Early presentation of men with cancer
Referral to secondary care
Complications of cancer
Examined all ‘Urgent suspected
cancer’ referrals by GPs over a six
month period across West of Scotland
Numbers of urgent referrals per
1000 population:
n = 1400
n = 2074
n = 5692
n = 2537
n = 11703
Number of urgent referrals per 1000
population by tumour type:
Proportion of urgent referrals where
same cancer diagnosed as
suspected:
n = 1400
n = 2074
n = 5692
n = 2537
n = 11703
Proportion of urgent referrals where
same cancer diagnosed by tumour
type:
Proportion of urgent referrals where
urgent referral complied with
guidelines by tumour type:
Specific projects relating to
Men’s Health and cancer within
WoSCAN
1.
2.
3.
4.
Bowel screening
Early presentation of men with cancer
Referral to secondary care
Complications of cancer
Safe management of cancer
complications and emergencies
Summary
• Cancer in Scotland is important
• Men have poorer outcomes with cancer
• WoSCAN working on number of initiatives to
understand and improve care that men with
cancer receive
How do we engage with men better?
[email protected]