Transcript Improving Cancer Outcomes in Camden

Improving Cancer Outcomes in Camden
Dr Lucia Grun
19 May 2014
1:00 pm
1:30 pm
Registration and Lunch
Improving Cancer Outcomes in Camden
Lucia Grun
2:15 pm
Early diagnosis of abdominal
symptoms
Andrew Millar
3:15 pm
3:30 pm
4:30 pm
Management of Myeloma
Neil Rabin
Refreshment Break
Early diagnosis of abdominal
Management of Myeloma
symptoms
Neil Rabin
Andrew Millar
Feedback and Close
Why does early diagnosis matter?
Five year relative survival rates
Five year survival of common cancers diagnosed
Early versus late
Breast
Late stage five year
relative survival
13% (IV)
Early stage five year relative
survival
92% (I)
Lung – Non-small cell
2-13% (4)
58-73% (1A)
Colorectal
6.6% (Dukes D)
93.2% (Dukes A)
Cancer
Directly standardised mortality rate aged under
75 for all cancers, Camden, 1993-2011
Source: Health and Social Care Information Centre, 2013, NB data for 2009-11 are provisional at the time of publication.
Camden-specific statistics…
• The reduction in Camden’s cancer rates has been faster over the past 10
years (27%) than England (22%) or London (25%)
• May relate to greater than average reduction in numbers of smokers in
Camden
• Camden also has a significantly higher proportion of cancers diagnosed at
stage 4 (late) compared to the London average
Camden Joint Strategic Needs Assessment 2013, Camden Council http://www.camden.gov.uk/ccm/content/social-careand-health/health-in-camden/joint-strategic-needs-assessment-2012/chapter-16-cancer.en?page=3
Quick view of Camden’s Cancer Profile
• A young population - 9% of Camden is 65+ (England
mean of 15.8%)
• Screening coverage is lower than England
Quick view of Camden’s Cancer Profile
• Number of TWW with a cancer diagnosis – 63 (3.8%
- lowest proportion in the UK)
• Percentage of new cancer cases treated which were
not TWW referrals – 67 (51.5%)
•
Screening? Incidental finding? Routine referral? A&E?
Previous experience
Lots of problems
in one
consultation
Pressure on
appointments
Multiple guidelines
Co-morbidities
in patients
Keeping up to date
Primary Care
Difficulties of access
Lack of coordination
across
pathways
Fear
Public Awareness
Lack of
knowledge
Secondary Care
Previous experience
Cultural Issues
Perceived
barriers to
Primary Care
Lack of direct
access to
diagnostics
Fatalism
Pressure
on
appoint
ments
Shortage of
diagnostic
appointments
No urgent
appointment
pathway
Pressures on Primary Care
National Patient Experience Survey for all cancers
Question 64: Practice staff definitely did everything they could to support patient
120%
100%
Trusts
BCFH
BHRUT
HUH
NMUH
PAH
RFL
RNOH
UCLH
WH
BH
2012
60.92%
60.50%
53.80%
62.55%
60.55%
48.89%
57.10%
60.00%
58.53%
2013
65.88%
59.31%
76.67%
57.54%
62.84%
63.82%
70.21%
55.92%
61.43%
62.39%
80%
60%
40%
Data
Source:
National
Cancer
Patient
Experience
survey
20%
0%
BCFH
BHRUT
HUH
NMUH
PAH
RFL
RNOH
UCLH
2012
2013
2012 LondonCancer Average
2013 LondonCancer Average
Top 20%
Bottom 20%
WH
BH
Primary Care Education Package
• Aligned with the Long Term Conditions Locally Commissioned Scheme (LCS)
• Part of CCG’s Long Term Conditions and Cancer programme priorities
• Available to all practices in Camden
• Includes
1. practice visits
2. education events
3. peer review meetings
Cancer
Diabetes
Hypertension
CKD
COPD
Heart Failure
Improving Cancer Outcomes in Camden.
A project funded by Camden CCG and
delivered by London Cancer.
What we are offering
1. Practice visits from Cancer Research UK Facilitator
2. Upper and Lower GI clinical audit
3. Running a local awareness campaign
4. BMJ online learning tool
5. Macmillan Referral Styles Pilot
1. Practice visits from Cancer Research UK Facilitator
• Visits are currently taking place across all practices
• 17 practices have arranged visits between May and July
• Opportunity to discuss GP profiles, cancer tools, sessions with practice staff
• If you wish to have a visit, please see Carol Murphy, the Camden Primary Care
Facilitator, [email protected]
2. Upper and Lower GI audit – background
• 1st April 2012-31st March 2013 for patients diagnosed with an upper or lower
GI cancer
• A total of 175 patients were identified and audited in both primary and
secondary care
• Currently - 82 audit submissions have been received from 15 practices across
Camden
• Data for all patients were received back from the Royal Free and UCLH –
allowing for a greater understanding of the entire patient pathway
Upper and Lower GI audit – preliminary results (as of 15/05/2014)
Total of 82 patients
By Cancer type
Male
58
Upper GI
18
Female
26
Lower GI
64
• Youngest patient was 42 years old
By Age
40-60
9
61-70
26
71-80
33
81-90
14
• Oldest patient was 90 years old
• Majority are male
• Higher diagnoses made in 71-80
age group
• Contact with GP
• High service users
• Only 2 patients did not see their GP before diagnosis
• Any interaction with primary care in 2 years before diagnosis (including
home visits, telephone calls):
• 0-10 interactions before diagnosis – 27 patients
• 10-20 interactions before diagnosis – 28 patients
• 20-30 interactions before diagnosis – 17 patients
• 30+ interactions – 10 patients
Most common comorbidities recorded
Essential hypertension (25%)
Chronic Kidney Disease (10%)
Diabetes (5%)
Most relevant symptoms in the Upper GI cases
Did your patient have any of the following symptoms in the last 2 years
previous to diagnosis?
Progressive weight Loss
30%
Iron Deficiency Anaemia
25%
Unexplained upper abdominal pain
25%
Dysphagia
10%
Dyspepsia> 6weeks
10%
Most relevant symptoms in the Lower GI cases
Did your patient have any of the following symptoms in the last 2 years
previous to diagnosis?
Change in normal bowel habit to diarrhoea/looser
stools
30%
Bleeding from back passage
20%
Abdominal pain
15%
Constipation
10%
Weight loss
5%
Lump in back passage or abdomen
5%
Blood in stools
5%
Nausea and vomiting
5%
Routes to diagnosis
• 2ww
• 65% of patients were referred to secondary care through the 2ww
• A&E
• 20% of patients were diagnosed through A&E
• Screening
• 10% had abnormal screening test results leading to diagnosis
• Other
• 5% were diagnosed through other means such as incidental findings or
routine referrals
3. Local awareness campaign – ‘the small c’
Who are we targeting in Camden?
1. Over 50s population
2. Bangladeshi population
- 4 most deprived wards of - Camden wide
Camden (Cantelowes,
- Led by the Bengali
Kilburn, Somers Town and
Workers Association
St Pancras, Haverstock)
- Led by Arsenal in the
Community & Tottenham
Hotspurs Foundation
4. BMJ OnExamination: Online learning tool for
Camden GPs
• An initial knowledge test. From this BMJ OnExamination will identify
knowledge gaps which will inform the development of learning modules to
target and improve knowledge in these specific areas
•
A programme of self assessment modules will be provided with relevant
learning material based on knowledge test results
• A post-test to confirm knowledge improvement by engaging with the self
assessment modules
Timescale: Over 18 – 24 months
Benefits to you:
•
•
•
•
At least 10 hours CPD on completion / Preparation for Appraisal
Improved knowledge in the early diagnosis and treatment of cancers
Assessment content is relevant to current GP practice & local guidelines
Assessments available anytime to fit in during surgery or work at
your own speed at home
• Revisit modules as often as you like for the duration of the programme
Benefits to Camden CCG:
• Improved patient outcomes
• Improved knowledge across key clinical areas, i.e. an improvement in earlier
cancer diagnosis rates and referrals
5. Macmillan Referral Styles - Recruiting now!
•
The project aims to deepen understanding of GP cancer referral
behaviour by testing the value of a framework designed to
identify differences in the way in which GPs refer
• Provides a view of GP referral styles where the focus is on
individual physicians; it is not a replication of ‘Routes to
Diagnosis’ nor a cancer epidemiology study
• Is based on a unique, bespoke dataset, combining real-world
patient level data on cancer patients and non cancer 2 Week
Wait referrals with detailed survey responses from the GPs
participating in the study:
• Survey responses from every treating GP give a unique insight
into referral behavior, and data not available in standard sources
Bowel Screening LCS (beginning in July 2014)
1) Health promotion payments– displaying material
2) Payment for letters - sending GP endorsement letters to all
patients being invited for Bowel Cancer Screening
3) Payment for follow up consultations - Follow-up
consultations (either telephone or face-to-face) with patients
who have not returned kit after 4 weeks
4) Payment for increases in uptake - Payment for increases in
uptake compared to 2013/14 baseline
5) Administration payments - Entry of bowel screening results
and other administration
What is the CANDID STUDY?
• Finding out what symptoms & examinations are best for predicting lung & bowel cancer.
• Funded by National Institute for Health Research National School of Primary Care Research.
• Multi-centred study coordinated from University of Southampton & led by Professor Paul Little.
What is involved for Practices?
Practices will identify 49 potential participants in 2 ways:
• Opportunistically during consultations.
• Database search & mail-out
GPs & Nurse Practitioners asked to:
• Collect clinical information using a standardised form
• Offer patient an optional blood/saliva sample & to complete a lifestyle questionnaire
• Complete a notes review for each patient 2 years after recruitment (takes approx. 15 minutes)
Service Support Costs:
• £49.61 per patient recruited plus an additional payment of £5.50 per study blood sample.
• This amounts to approx. £2,430.00 for 49 patients
For more information please contact:
Eloise Radcliffe, London Co-ordinator: 020 7794 0500 x 36730 [email protected]
Please stay in this room to hear about myeloma diagnosis and
management with Dr Neil Rabin
Please follow Hannah to the next room for the session with Dr
Andrew Millar on management of abdominal symptoms
There will be a refreshment break at 3:15pm
1:00 pm
1:30 pm
Registration and Lunch
Improving Cancer Outcomes in Camden
Lucia Grun
2:15 pm
Early diagnosis of abdominal
symptoms
Andrew Millar
3:15 pm
3:30 pm
4:30 pm
Management of Myeloma
Neil Rabin
Refreshment Break
Early diagnosis of abdominal
Management of Myeloma
symptoms
Neil Rabin
Andrew Millar
Feedback and Close
See you at the next Education
Event!
Friday 20th June: Diabetes
Wednesday 16th July: Heart Failure
Registration:
http://www.camdenccg.nhs.uk/gps/camden-gp-education-programme