Transcript Associate Professor Susan Parry

Colorectal Cancer Programme
Screening for Colorectal Cancer
A/P Susan Parry, Gastroenterologist, CD MOH Bowel Cancer Programme
PREPARED BY
Ministry of Health Bowel Cancer Work Programme
•
Bowel Screening Pilot – result recommendations previous working groups
•
Colonoscopsy wait time indicators
•
National Endoscopy Quality Improvement Programme
•
NZ Familial Gastrointestinal Service
•
Standards of service provision for bowel cancer Dec 2013
•
Work force planning with Health Workforce NZ
•
Supported by the National Bowel Cancer Working Group
•
Bowel Screening Advisory Group – subgroup NBCWG
•
Liasing with relevant professional bodies
Colonoscopy past and present wait time indicators
Target
Waiting time
indicator
classification
Urgent
Non urgent
Surveillance
Waiting time indicator
classification
Criteria
Received or waiting less than 14 days
Received or waiting less than 42 days
Received or waiting less than 84 days
2012/13 2013/14 2014/15 2015/16*
50%
50%
75%
75%
50%
50%
60%
65%
50%
50%
60%
65%
Numerator
Denominator
Urgent
Received or waiting less than 14 days
Non urgent
Received or waiting less than 42 days
Surveillance
Received or waiting less than 84 days
Total patients waiting who have received an
urgent colonoscopy or waiting for an urgent
colonoscopy
Total patients waiting who have received a
non urgent colonoscopy or waiting for a non
urgent colonoscopy
Total patients waiting who have received an
surveillance colonoscopy or waiting for an
surveillance colonoscopy (past the planned
date)
Colonoscopy Wait – Time Indicators
Wrap round initiatives
• Development of national
• National Endoscopy Quality Improvement Programme
• Utilising Global Rating Scale for endoscopy units as in UK
• MOH bowel cancer team visits/communication DHB’s
• Provide high level support to deliver sustainable increase in
colonoscopy capacity
National progress : timely colonoscopy delivery
Number of colonoscopies performed
Colonoscopy: numbers waiting
May results: Urgent
May results: Non urgent
June 2014 results: Non urgent
Number of colonoscopies performed
Q1
2012/13
2013/14
2014/15
12,000
Q2
8,703
7,725
8,859
Number performed
Q3
Q4
Total
7,044
6,864
7,511
30,122
6,930
7,396
10,273
32,324
9,290
8,809
9,118
36,076
Colonoscopies performed by financial year
Numbers performed
10,000
8,000
6,000
4,000
Q1
Q2 Q3 Q4
17%
2,000
-17%
2012/13
18
18
4
20
18
23
22
17
Q4
32
10
Q1
Q3
Q2
53
16
27
17
12
17
19
16
-1
15
-17 2013/14 8
Q1 Q2 Q3 Q4
2014/15
Numbers waiting for a colonoscopy
Numbers waiting
Q2
Q3
Q1
2012/13
2013/14
2014/15
11,451
9,798
12,123
8,330
Q4
12,429
8,122
9,361
7,721
Numbers waiting by financial year
14,000
initiative
3357
12,000 27.0
10,000
8,000
6,000
Q1
Q2
Q3
Q4
4,000
Q1
Q2
Q3
2,000
2013/14
2014/15
Q4
Bowel Screening Pilot
Bowel Screening Pilot commenced in Waitemata DHB October 2011
Waitemata Bowel Screening Pilot (BSP)
•
Duration 4 years, two screening rounds
•
Age range 50-74yrs, men & women (approximately 136,000 eligible people)
•
Screening test
•
FIT (OC – Sensor) is mailed to eligible participants and completed at home
- faecal immunochemical test for haemoglobin (FIT)
- every two years
- predetermined cut off for positivity
Acknowledge the hard work and commitment
of the Waitemata Team.
Mike Hulme Moir, Clinical Director
Gaye Tozer, Manager
Service delivery model
Community Engagement and Awareness Raising
Invitation pathway
Faecal Occult Blood Test Kit Returned, Processed
Negative
Recall
Colonoscopy/Radiology +/ Histology
No significant
neoplasia
Recall
Positive
High Risk
Adenoma
Surveillance
Cancer
Treatment
Patient Navigation and Support
Local Involvement and Regional Coordination
Identification
Round 1 results:
Between 1 January 2012 and 31 December 2013:*
•
Over 121,000 eligible people invited to take part in the Pilot
•
Coverage 97.5% (based on census data)
•
The programme participation rate was 55.8%
•
Overall positivity rate was 7.5%
•
96% of those with a +ve FIT went to colonoscopy
•
CRCs found in 186 (22) people (46.2% TNM Stage 1)
*
Data pulled March 2015
Participation in the BSP
Round 1 and the first year of Round 2
Participation in the BSP, by age and sex
Round 2
Participation in the BSP by ethnicity
Round 1 and the first year of Round 2
Participation in the BSP by deprivation group
Round 1 and the first year of Round 2
Positivity in the BSP
Round 1 and the first year of Round 2
Bowel Screening Pilot results to Dec 2014
Rd 1
Rd 2
CRC detection rate DR/1000 screened
2.8
Advanced adenoma DR
15.9
7.5
Adenoma DR
36.9 (13.3-22.3)
22.8
PPV CRC %
4.2 (4.5-8.6)
2.6
PPV Advanced adenoma %
24.2
(1-8-9.5)
1.3
15.2
PPV adenoma %
56.1 (9.6-40.3)
Those with low risk adenoma returned to screening
Remainder offered ongoing colonoscopic surveillance
46.5
Next steps
• BSP extended until end Dec 2017 – opportunity to trial some new initiatives
• Consultation to inform a business case
• a phased restricted age national roll out beginning 2017
• Results from Round 1 & 2 to inform decisions re phased roll out to
• maximise cancer detection within potentially available colonoscopy
resource ( need to ensure timely symptomatic/surveillance procedures)
• maximise cancer detection/ minimise detection low risk lesions for
participants
• minimise disparities
• ensure quality maintained
• optimise cost effectiveness
Next Steps
•
Continue to monitor
• progress screening programmes in other countries
• new screening tests
•
In determining phased roll out options consider possibility of subsequent
inclusion of other screening tests eg flexible sigmoidoscopy as in UK
•
Continue international dialogue/peer review/meetings – MOH & BSAG
Waitemata BSP Team
Ministry of Health Bowel & Prostate
Cancer Team