Transcript WCISU - Using cancer registry data to plan

Using cancer
registry data to
plan cancer
services in Wales
Public Health Wales Staff Conference
15th October 2009
Welsh Cancer Intelligence and Surveillance Unit (WCISU)
Outline
• Background to WCISU
• Overview of publications
• Planning cancer services case studies
1. Age Period Cohort Modelling
2. Distance to Treatment
3. Supporting Public Health – Research
• How to request information
• Sources of further information
Who are we?
The Welsh Cancer Intelligence & Surveillance
Unit
With an All Wales remit for the registration,
analysis and dissemination of cancer
information for the resident population of
Wales and patients treated in Wales
Where are we?
 Based in Brunel House in Cardiff.
 Undertakes work at all Hospital sites
across Wales across Wales
How many of us?

22 staff based in Cardiff

2 Peripatetic Staff based in North and
West Wales
WCISU Roles
Interdependency between all staff groups:
Registration / I.T. / Statistics/ Admin.
Overview of Publications
• Cancer Incidence in Wales
Published annually for last five years of diagnosis
• Triennial report
Published every three years with detailed incidence,
mortality, prevalence and survival data
• Occasional reports
Published during each year as and when on website
• Fact sheets
Site specific factsheets with input from clinicians
Local Health Boards for most common cancers
Case Study 1:
Age Period Cohort
(APC) modelling
APC modelling (1)
• Produced for a Pilot Project developed under the auspices
of Cancer Services Coordinating Group
• Aim to derive realistic scenarios for large bowel cancer
services up to 2015 in order to inform the final National
Service Framework
• Age, Period of diagnosis and birth Cohort are relevant
predictors of cancer incidence and mortality trends
• Based on assumption that the number of cases in each
age group in each period follows a Poisson distribution
• Fit Poisson regression models to the data and describe the
incidence rate as a function of age, calendar period and
birth cohort.
APC modelling (2)
• The model is parameterised to include a drift parameter,
which describes the linear trend not attributable to either
period or cohort effects
• The ‘best’ model for each site/sex combination was found
and used to project future trends
Table 1: Rectal cancer incidence
1974-1978
1979-1983
1984-1988
1989-1993
1994-1998
1999-2003
2004-2008
2009-2013
2014-2018
Observed
Cases
1532
1884
2313
2092
2141
2197
Male
Best
Model
2336
2502
2661
Best model: APC
ASR
2380
2615
2875
ASR: Age Specific Rates (using 1999-2003 data)
APC: Age Period Cohort model
APD: Age Period Drift Model
Observed
Cases
1159
1615
1749
1482
1397
1391
Female
Best
Model
1324
1276
1248
Best model: APD
ASR
1445
1521
1622
APC modelling (3)
Clayton and Schifflers APC model fitted
well, except for prostate cancer – growth
unrealistically steep
 further investigations during a intercalated
Public Health Project (Natalie Willams –
BSc 1st class hons)
 Effect of a power link versus a log link as
advocated by Moller et al
 Effect of “tapering off” the contribution of
the linear drift term also by Moller
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What is the significance of a power
link versus a log link?
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Poisson regression model can be written using a
log link as a linear model:Log(Yijk)= age + period +cohort +drift
To invert the log link we take exp( ) of both
sides
Using a power link it can be written as:(Yijk)^0.2= age + period +cohort +drift
Now we raise to the fifth power which gives
more gradual growth than exp( )
APC modelling (3)
• Projections of incidence/mortality figures into the
future should always be viewed with caution – not an
“exact” science – based on historic data
• There is substantial demand for high quality
projections of incidence and mortality in cancer
service planning in Wales
•Skill with both epidemiology and Generalised Linear
Modelling required – labour intensive
• APC modelling future trends of cancer was
extended to other major cancer sites in 2008 and are
available on our website
Case Study 2:
Distance to
Treatment Analysis
Distance to treatment analysis (1)
• Three requests for this type of information:
1.Velindre Cancer Centre
(To determine future locations and capacity for non surgical
oncology services including satellite units)
Numbers of people travelling to Velindre Cancer Centre to get
chemotherapy and distance travelled
2.Velindre Cancer Centre & Prof Ilora Finlay
(To determine those that travel to England for chemotherapy to try
and treat them in Wales)
Hospital of chemotherapy for those people living in Powys and
distance travelled
3.Tenovus
(To determine possible sites for a Mobile Cancer Support
Unit in South Wales)
Numbers of people that travel from LHB of residence to LHB of
first chemotherapy and distance travelled
Distance to treatment analysis (2)
Example of analysis for Tenovus- data matrix:
LHB of residence
Anglesey
Gwynedd
Conwy
Denbighshire
Flintshire
Wrexham
Powys
Ceredigion
Pembrokeshire
Carmarthenshire
Swansea
Neath Port Talbot
Bridgend
Vale of Glamorgan
Rhondda Cynon Taff
Merthyr Tydfil
Caerphilly
Blaenau Gwent
Torfaen
Monmouthshire
Newport
Cardiff
WALES
0-5
13.2
17.0
18.7
49.0
2.8
31.2
0.7
25.5
13.9
17.4
75.1
0.9
3.3
18.8
5.0
2.2
13.4
0.2
5.6
3.5
19.7
91.0
26.2
5-10
21.2
9.8
20.1
29.8
28.7
7.5
0.7
9.3
30.9
29.9
22.4
66.5
2.5
55.8
37.8
1.4
41.0
15.6
14.4
4.8
20.0
8.3
24.2
DISTANCE CATEGORY (MILES)
10-20
20-30
30-50
50+
34.1
15.4
12.5
3.5
27.4
21.8
18.2
5.7
57.7
1.1
1.6
0.8
14.7
6.0
0.2
0.3
60.5
6.9
1.1
0.0
1.6
56.8
2.7
0.2
31.7
28.0
20.9
17.9
29.2
17.5
12.5
6.0
32.6
3.6
11.0
8.0
38.8
7.6
4.4
1.9
0.7
0.0
1.6
0.1
29.2
2.7
0.4
0.4
73.1
20.5
0.0
0.5
24.6
0.5
0.0
0.3
54.2
2.7
0.1
0.3
89.9
6.5
0.0
0.0
44.7
0.5
0.0
0.4
81.3
1.9
0.2
0.7
78.8
0.7
0.0
0.5
24.1
60.5
6.4
0.7
60.2
0.0
0.0
0.2
0.0
0.0
0.1
0.6
34.6
9.4
3.6
2.0
TOTAL
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
Subsequent analysis calculated the minimum distance travelled to three potential locations for the Mobile
Cancer Support Unit in Powys:
LHB of residence
Powys
0-5
27.6
5-10
22.7
10-20
40.5
20-30
9.2
30-50
0.0
50+
0.0
TOTAL
100.0
Case Study 3:
Supporting Public
Health - Research
Supporting Public Health (1)
Nant-Y-Gwyddon Landfill Site
• WCISU alerted by local residents with regards to high
incidence of NHL around the landfill site and analysis was
commissioned by WAG
• Findings presented at UKACR conference in Leeds,
September 2002 and EUROHEIS conference, Sweden,
March 2003
• WCISU continue to monitor NHL incidence in this area
Observed
Expected
Observed-Expected
Age standardised relative risk (RR)
(95% CI)
Age standardised incidence rate
per 100,000 population (95% CI)
1983-1987 1988-1992 1993-1997 1998-2002 2003-2005
8
20
12
27
6
11.65
15.10
16.81
18.16
12.19
-3.65
4.90
-4.81
8.84
-6.19
0.69
1.32
0.71
1.49
0.49
(0.30,1.35)
(0.81,2.05)
(0.37,1.25)
(0.98,2.16)
(0.18,1.07)
7.20
18.06
10.62
23.91
9.05
(2.21,12.20) (10.14,25.99) (4.60,16.63) (14.88,32.94) (1.80,16.31)
Non Hodgkin’s Lymphoma Cases within 1km and 2.5km
of Nantygwyddon Landfill Site
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Welsh Cancer Intelligence & Surveillance Unit
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Uned Arolygiaeth a Gwybodaeth Cancr Cymru
Aggregating population at risk
Census population data (and mid year estimates) for all Wales
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WITHIN RADIUS
WITHIN WHOLE WARD
Pcodes within Domestic within Pcodes within Domestic within Proportion
49
1321
49
1321
100.0
66
937
70
1020
91.9
70
1374
127
2462
55.8
57
1132
93
1568
72.2
12
451
91
1835
24.6
127
2716
127
2716
100.0
Apply proportion to census data for small geographical units.
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Welsh Cancer Intelligence & Surveillance Unit
Uned Arolygiaeth a Gwybodaeth Cancr Cymru
Supporting Public Health (2)
Childhood Leukaemia in Menai Straits
• A study by Green Audit, an “environmental
consultancy”claimed significant increased risks of
childhood leukaemia in Menai Straits 28x !
• WCISU repeated the analysis using the data and found no
evidence of increased risks in the specified area
• WCISU concluded these were the results Data errors and
methodological flaws by Green Audit
•

“There is abundant evidence that the health effects of
releasing low levels of radioactivity into the environment
are hundreds of times greater than governments can
afford to admit.

They can only sustain the lie by means of attacking the
truth. This is one aspect of the Science Wars in which the
demands of commerce and national interest confront the
public interest and public health.

Wings of Death and now Wolves of Water are dispatches
from the front — necessary reading for campaigners,
scientists, sociologists, historians”
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[http://www.llrc.org/wings/wingspage.htm]
Probe this cancer cluster in kids
Jul 22 2004
by Robert Merrick, Daily Post
FORMER UK environment minister Michael Meacher has
demanded an independent probe into claims of a "cancer
cluster" in North Wales children linked to nuclear power.
The highly-respected Labour MP claimed controversial
research, suggesting child leukaemia in the Menai Strait
area is 28 times the UK average, had not been properly
investigated.
The nuclear industry and the Welsh Cancer Intelligence
and Surveillance Unit have dismissed the findings.
But Mr Meacher said two existing watchdogs did not have
the muscle to do the job because they were not fully
independent and should therefore be scrapped.
Welsh Cancer Intelligence & Surveillance Unit
Uned Arolygiaeth a Gwybodaeth Cancr Cymru
Ogwen RD
(a) Urban AoR on the “coastal strip”
Aethwy RD
Gwyrfai RD
(c) “Menai” shaded and
“Caernarfon” outlined
(b) AoR selected by Green Audit
Bangor
MB
Colwyn Bay MB
Caernarfon
MB
Welsh Cancer Intelligence & Surveillance Unit
Uned Arolygiaeth a Gwybodaeth Cancr Cymru
20
15
10
0
5
R e la tive R isk (O /E )
1
2
3
4
Log Population Size 0-4yrs
Welsh Cancer Intelligence & Surveillance Unit
Uned Arolygiaeth a Gwybodaeth Cancr Cymru
“Menai cluster” results
Campaign group had used AoR coded data
unsuitable for small area analysis –leads to
spurious clusters
 Post hoc selection of time and spatial
boundaries had inflated the effect from RR=
=1.82 (0.87,3.34) based on 10 cases to a
nominally significant RR=7.14 (3,08,14.06)
based on 8 cases.
 Data dredging produces spurious p values
 Evidence that they had trawled through the data

Welsh Cancer Intelligence & Surveillance Unit
Uned Arolygiaeth a Gwybodaeth Cancr Cymru
Supporting Public Health (3)
Childhood Cancer Incidence in the Chepstow area
• WCISU were asked by the WAG CMO for advice on a report
written by Green Audit that claimed to have found a “cluster” of
childhood cancers in children living in the Chepstow area,
within 10 km of the Oldbury nuclear power station
• Differences between both reports – marginal evidence of a
slight increased risk
• Very small numbers
• Findings were presented to COMARE and referenced in their 10th
report
How to request information (1)
• Phone (029) 2037 3500
• Visit www.wcisu.wales.nhs.uk and link to Request Service
• Two data request forms:
* Summary of data form – available by
email/post/internet
* Patient Identifiable Information – available by
email/post
How to request information (2)
th
WCISU, 13 Floor, Brunel House, 2 Fitzalan Road, Cardiff, CF24 0HA, Tel: 029 2037 3500, Fax: 029 2050 2121
Welsh Cancer Intelligence & Surveillance Unit
Uned Arolygiaeth a Gwybodaeth Cancr Cymru
DATA REQUEST FORM – SUMMARY INFORMATION
Please complete requested information, use tab key to move between fields:
Personal Details
Title
Mr
Name
Occupation
Address
Phone Number
Email
Do you want this information by sex?
Male cases only
Do you want the data broken down into 5 year age
bands or do you just need data for all ages combined?
By 5 year age band
What year(s) of data do you need (if just one year of
data please fill this year in both boxes):
From 1983 to 1983
Do you want these years aggregated or provided
individually (e.g. to see trends)?
Aggregated
@
For which cancer sites do you require data?
Please list sites here:
Please indicate the reason for the data request:
Service planning
Report
Epidemiological research*
Dissertation*
Clinical research*
Meeting
Presentation
Clinical Audit*
Conference
Publication
Media enquiry
Other
If other please specify:
Cancer network/site
specific group
* A copy of a study/audit protocol is required before data can be released
To what level of geographical detail do you require this data?
Wales
Cancer Network
Local Health Board
If you only require specific areas please specify them here:
Any other information?
Data requirements:
Data Format
Please indicate which items of information you are interested in:
Incidence
Mortality
Survival*
Prevalence*
* please ensure you have given either email, postal address or telephone number if requesting survival or
prevalence figures and we will contact you to discuss what we are able to provide
How would you like this data sent?
Post
Is there a deadline for receipt of the data?
Yes
Email
If yes please specify reason here:
Declaration :
If you have requested incidence or mortality data please indicate which of the
following items/calculations you require:
Welsh Cancer Intelligence & Surveillance Unit will be acknowledged in any publications or
presentations based on the data provided.
Number of Cases
Signed:
Crude Rate
Date:
Directly Age Standardised Rates (usually to European Population)
Users
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General Public
Researchers/students
Clinicians
Local Health Boards
Welsh Assembly
NPHS
Cancer Networks
European & International Studies
ONS
Cancer Research UK
Cancer Charities
Uses
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Project work
Audit
Collaborative Studies
Cluster Investigations
Resource Allocation
Service Planning
Genetic Queries
Cancer Trends
Screening Effectiveness
Relationships with
geographical/socio-economic
factors
Sources of Further Information

Website
◦ www.wcisu.wales.nhs.uk
 Publications on incidence, mortality & survival
 Trends in incidence for most common cancers,
1985-2007
 Site specific fact sheets and LHB fact sheets
 Research reports
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Phone (Statistics Team)
◦ 029 2037 3500