Improving Cancer Outcomes in Camden

Dr Lucia Grun

19 March 2014

International Cancer Benchmarking Partnership: 5 year relative survival, patients diagnosed 1995-2007: Coleman et al, Lancet 2011

International Cancer Benchmarking Partnership: 5 year relative survival, patients diagnosed 1995-2007: Coleman et al, Lancet 2011

Cancer Late stage five year relative survival

Early stage five year relative survival

Breast 13% (IV) 92% (I)

Lung – Non-small cell 2-13% (4) 58-73% (1A)

Colorectal 6.6% (Dukes D) 93.2% (Dukes A)

Five year survival of common cancers diagnosed Early versus late

Camden-specific statistics…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.

5

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

• In Camden, a higher proportion of people are diagnosed at stage 1 (34%) compared to neighbouring boroughs and the London average.

• 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-care-and-health/health-in-camden/joint-strategic-needs-assessment-2012/chapter-16-cancer.en?page=3

6

National Patient Experience Survey for all cancers Question 64: Practice staff definitely did everything they could to support patient

Trusts 2012 2013BCFH 60.92% 65.88%BHRUT 60.50% 59.31%HUH 76.67%NMUH 53.80% 57.54%PAH 62.55% 62.84%RFL 60.55% 63.82%RNOH 48.89% 70.21%UCLH 57.10% 55.92%WH 60.00% 61.43%BH 58.53% 62.39%

Data Source:National Cancer Patient Experience survey

7

3 year funded project Camden CCG and LondonCancer

Delivered through other workstreams

Improving outcomes for Camden patients

Improve earlier diagnosis of cancer•Developing educational opportunities

o Online learning packageo Integrate results of recent GP questionnaire

•Linking into national awareness campaigns•Reflection on current practice through various methods•Best Commissioning Pathways from NHS England

Improve communication •Interface between primary and secondary care•Facilitate connections between practices and CCG•London Cancer as a way to support this

Improve pathways for patients who present late•Learning from the A&E Audit

• Encourage stronger links into national awareness campaignso Awareness of key messages o Available leaflets and promotion in practices

• Access to appointmentso Patient perceptions

• Uptake in screening programmeso Cervicalo Bowelo Breast

Earlier Diagnosis – Practice based

• Education of reception staff

• Appropriate use of 2ww referral between primary and secondary care

• Creating a low risk but not no risk culture

Earlier Diagnosis - Communication

Earlier Diagnosis - Reflection

• Significant event analysis

• Audit of past cancer diagnoseso Understand patient journey and route to diagnosiso Upcoming audit

• Sharing learning within practices and localitieso Best practice and insights across Camden

• Using practice profileso Available at today’s event

• MacMillan Risk Assessment Tools

Best Practice Pathways for early detection

Numbers of ovarian cancers detected in a theoretical cohort of 100,000 with symptoms consistent with ovarian cancer presenting to primary careAssumed prevalence of undiagnosed ovarian cancer is 0.23% in women with such symptoms- total numbers of ovarian cancer cases is 230

Source: Transforming Cancer Services for London, Best Practice Commissioning Pathway for the early detection of ovarian cancer , NHS England