West of Scotland Cancer Network Upper Gastro-intestinal Cancer … · 2019. 4. 15. · West of...

The content of this report is © copyright WoSCAN unless otherwise stated.

Audit Report

Upper GI Cancer Quality Performance Indicators

Report of the 2017 Clinical Audit Data

Mr Matthew Forshaw MCN Clinical Lead Tracey Cole MCN Manager David New Information Officer

West of Scotland Cancer Network Upper Gastro-intestinal Cancer Managed Clinical Network

West of Scotland Cancer Network Final Published Upper Gastro-intestinal Cancer MCN Audit Report v1.0 15/11/2018 2

CONTENTS

EXECUTIVE SUMMARY 3

1. INTRODUCTION 12

2. BACKGROUND 12

2.1 NATIONAL CONTEXT 13

2.2 WEST OF SCOTLAND CONTEXT 14

3. METHODOLOGY 17

4. RESULTS 18

4.1 DATA QUALITY 18

4.2 PERFORMANCE AGAINST QUALITY PERFORMANCE INDICATORS 19

5. CONCLUSIONS 50

6. ACKNOWLEDGEMENTS 52

7. ABBREVIATIONS 53

8. REFERENCES 54

APPENDIX 1: NHS BOARD ACTION PLANS 56


EXECUTIVE SUMMARY

Introduction This report presents an assessment of performance of West of Scotland Upper Gastro-intestinal (GI) Cancer Services relating to patients diagnosed in the region between 01 January 2017 and 31 December 2017. Data was measured against v3.0 of the Upper GI Cancer Quality Performance Indicators (QPIs)1. This was the fifth consecutive year of analysis following the initial Healthcare Improvement Scotland (HIS) publication of Upper GI cancer QPIs in 2012.

Background There were 707 new cases of Upper GI cancer diagnosed in total in the West of Scotland (WoS) in 2017 (520 oesophageal, 187 gastric). Analysis of the data contained within this report is based on the NHS Board responsible for treatment. Outcome measures regarding the quality of surgical services have been analysed based on the NHS Board where surgery was performed. Quality assurance and continuous service improvement will be supported by regular assessment of service performance against the nationally defined QPI criteria. Methodology The clinical audit data presented in this report were collected by clinical audit staff in each NHS Board in accordance with an agreed dataset and definitions. Data were recorded manually and entered locally into the electronic Cancer Audit Support Environment (eCASE): a secure centralised web-based database. Data relating to patients diagnosed between 01 January 2017 and 31 December 2017 were downloaded from eCASE at 2200 hrs on 04 July 2018. Analysis was performed centrally for the region by the WoSCAN Information Team and the timescales agreed took into account the patient pathway to ensure that a complete treatment record was available for each case. Initial results of the analysis were provided to local Boards to check for inaccuracies, inconsistencies or obvious gaps and a subsequent download taken upon which final analysis was carried out. The final data analysis was disseminated for NHS Board verification in line with the regional audit governance process to ensure that their data were an accurate representation of service in each area. Results The data are measured against ISD QPI measurability criteria and the results are summarised below as the overall result for WoSCAN and the range across NHS Boards in relation to the QPI targets. Figures are expressed in percentages and separately for oesophageal and gastric cancers where appropriate.


Performance Summary Report

OESOPHAGEAL CANCER Quality Performance Indicator (QPI)

Performance by Board

QPI target AA FV GGC Lan WoS

QPI 1: Endoscopy – Proportion of patients with oesophageal cancer who have a histological diagnosis made within 6 weeks of initial endoscopy and biopsy.

95% 89.9% > 100.0% > 92.7% > 100.0% > 94.4% >

71 79 52 52 267 288 95 95 485 514

QPI 3: MDT Meeting – Proportion of patients with oesophageal cancer who are discussed at MDT meeting before definitive treatment.

95% 94.8% > 96.2% > 96.9% > 91.4% < 95.5% >

73 77 51 53 277 286 85 93 486 509

QPI 4(i): Staging and Treatment Intent – Proportion of patients with oesophageal cancer who have (i) TNM stage recorded at MDT meeting prior to treatment.

90%

97.5% < 98.1% > 90.3% > 94.8% < 93.1% <

79 81 52 53 262 290 91 96 484 520

QPI 4(ii): Staging and Treatment Intent – Proportion of patients with oesophageal cancer who have (ii) treatment intent recorded at MDT meeting prior to treatment.

95%

98.8% < 100.0% > 84.8% < 94.8% < 90.4% <

80 81 53 53 246 290 91 96 470 520

QPI 5(i): Nutritional Assessment – Proportion of patients with oesophageal cancer who undergo nutritional screening with the MUST before first treatment.

95%

60.0% 67.9% 81.0% 26.0% 66.3%

48 80 36 53 235 290 25 96 344 519

QPI 5(ii): Nutritional Assessment – Proportion of patients with oesophageal cancer at high risk of malnutrition (MUST score of 2 or more).

90%

100.0% 100.0% 95.7% 100.0% 97.4%

24 24 23 23 89 93 13 13 149 153

QPI 6: Appropriate Selection of Surgical Patients – Proportion of patients with oesophageal cancer who receive neo-adjuvant chemotherapy or chemoradiotherapy who then go on to have surgical resection.

80%

60.0% < 42.9% < 60.0% < 66.7% < 59.4% <

6 10 3 7 21 35 8 12 38 64

QPI 7 (a)†: 30 day Mortality Following Surgery -

Proportion of patients with oesophageal cancer who die within 30 days of surgical resection.

< 5% 0.0% = * 0.0% > 0.0% = 0.0% >

0 6 * * 0 26 0 8 0 40





QPI 7 (b)†: 90 day Mortality Following Surgery -

Proportion of patients with oesophageal cancer who die within 90 days of surgical resection.

< 7.5%

- * 0.0% > 0.0% > 0.0% >

- - * * 0 22 0 8 0 34

QPI 8†: Lymph Node Yield – Proportion of patients

with oesophageal cancer who undergo surgical resection where ≥15 lymph nodes are resected and pathologically examined.

90%

100.0% > * 70.4% < 50.0% < 70.7% <

6 6 * * 19 27 4 8 29 41

QPI 9†: Length of Hospital Stay Following Surgery

– Proportion of patients undergoing surgical resection for oesophageal cancer who are discharged within 14 days of surgical procedure.

60%

71.4% > * 59.4% > 33.3% > 53.7% >

5 7 * * 19 32 5 15 29 54

QPI 10(i)†: Resection Margins – Proportion of

patients with oesophageal cancer who undergo surgical resection in which surgical margin is clear of tumour, i.e. negative surgical margin (i) circumferential

70%

33.3% < * 74.1% < 50.0% > 63.4% <

2 6 * * 20 27 4 8 26 41

QPI 10(ii)†: Resection Margins – Proportion of

patients with oesophageal cancer who undergo surgical resection in which surgical margin is clear of tumour, i.e. negative surgical margin (ii) longitudinal

90%

100.0% = * 100.0% > 100.0% = 100.0% >

6 6 * * 27 27 8 8 41 41

QPI 11: Curative Treatment Rates – Proportion of patients with oesophageal cancer who undergo curative treatment.

35%

21.5% < 26.0% < 26.6% < 17.7% < 24.1% <

17 79 13 50 77 290 17 96 124 515

QPI 12 (i): 30-day Mortality Following Oncological Treatment – Proportion of patients with oesophageal cancer who die within 30 days of curative oncological treatment. (a) Chemoradiotherapy

<5%

- - 3.6% < - 2.6% =

- - - - 1 28 - - 1 39





QPI 12 (i): 90-day Mortality Following Oncological Treatment – Proportion of patients with oesophageal cancer who die within 90 days of curative oncological treatment. (a) Chemoradiotherapy

<7.5%

- - 3.8% < - 5.6% <

- - - - 1 26 - - 2 36

QPI 12 (i): 30-day Mortality Following Oncological Treatment – Proportion of patients with oesophageal cancer who die within 30 days of curative oncological treatment. (b) Peri-operative chemotherapy

<5%

0.0% = 14.3% < 0.0% = 0.0% = 1.5% <

0 11 1 7 0 35 0 12 1 65

QPI 12 (i): 90-day Mortality Following Oncological Treatment – Proportion of patients with oesophageal cancer who die within 90 days of curative oncological treatment. (b) Peri-operative chemotherapy

<7.5% 0.0% > 14.3% > 0.0% > 9.1% < 3.4% >

0 9 1 7 0 31 1 11 2 58

QPI 12 (ii): 30-day Mortality Following Oncological Treatment – Proportion of patients with oesophageal cancer who die within 30 days of palliative oncological treatment.

(c) Chemotherapy

<5%

4.0% > 0.0% = 6.5% < 4.5% < 5.0% <

1 25 0 10 4 62 1 22 6 119

GASTRIC CANCER Quality Performance Indicator (QPI)



QPI 1: Endoscopy – Proportion of patients with gastric cancer who have a histological diagnosis made within 6 weeks of initial endoscopy and biopsy.

95%

87.5% < 100.0% = 84.2% < 89.2% < 87.1% <

21 24 14 14 80 95 33 37 148 170

QPI 3: MDT Meeting – Proportion of patients with gastric cancer who are discussed at MDT meeting before definitive treatment.

95%

91.3% < 100.0% > 93.9% < 78.6% < 90.4% <

21 23 14 14 93 99 33 42 161 178





QPI 4(i): Staging and Treatment Intent – Proportion of patients with gastric cancer who have (i) TNM stage recorded at MDT meeting prior to treatment.

90%

100.0% = 100.0% = 85.0% < 97.7% < 91.4% <

27 27 16 16 85 100 43 44 171 187

QPI 4(ii): Staging and Treatment Intent – Proportion of patients with gastric cancer who have (ii) treatment intent recorded at MDT meeting prior to treatment.

95%

92.6% < 87.5% < 89.0% < 88.6% < 89.3% <

25 27 14 16 89 100 39 44 167 187

QPI 5(i): Nutritional Assessment – Proportion of patients with gastric cancer who undergo nutritional screening with the MUST before first treatment.

95%

48.1% 68.8% 84.0% 11.4% 60.4%

13 27 11 16 84 100 5 44 113 187

QPI 5(ii): Nutritional Assessment – Proportion of patients with gastric cancer at high risk of malnutrition (MUST score of 2 or more).

90%

85.7% 100.0% 89.3% - 91.5%

6 7 8 8 25 28 - - 43 47

QPI 6: Appropriate Selection of Surgical Patients – Proportion of patients with gastric cancer who receive neo-adjuvant chemotherapy or chemoradiotherapy who then go on to have surgical resection.

80%

- - 75.0% > 60.0% < 75.0% >

- - - - 6 8 3 5 12 16

QPI 7 (a)†: 30 day Mortality Following Surgery -

Proportion of patients with gastric cancer who die within 30 days of surgical resection.

<5%

- * 0.0% > 0.0% = 0.0% >

- - * * 0 13 0 9 0 23

QPI 7 (b)†: 90 day Mortality Following Surgery -

Proportion of patients with gastric cancer who die within 90 days of surgical resection.

<7.5%

- * 0.0% > 0.0% = 0.0% >

- - * * 0 12 0 8 0 21

QPI 8†: Lymph Node Yield – Proportion of patients

with gastric cancer who undergo curative surgical resection where ≥15 lymph nodes are resected and pathologically examined.

80%

- * 77.8% > 75.0% > 77.8% >

- - * * 7 9 6 8 14 18





QPI 9†: Length of Hospital Stay Following Surgery

– Proportion of patients undergoing surgical resection for gastric cancer who are discharged within 14 days of surgical procedure.

60%

- * 89.5% > 44.4% < 76.7% >

- - * * 17 19 4 9 23 30

QPI 10(ii)†: Resection Margins – Proportion of

patients with gastric cancer who undergo surgical resection in which surgical margin is clear of tumour, i.e. negative surgical margin (ii) longitudinal

90%

- * 92.9% < 100.0% = 95.8% <

- - * * 13 14 9 9 23 24

QPI 11: Curative Treatment Rates – Proportion of patients with gastric cancer who undergo curative treatment.

35%

3.8% < 7.1% < 14.0% < 25.0% > 14.7% <

1 26 1 14 14 100 11 44 27 184

QPI 12 (i): 30-day Mortality Following Oncological Treatment – Proportion of patients with gastric cancer who die within 30 days of curative oncological treatment. (a) Chemoradiotherapy

<5%

* * * * *

* * * * * * * * * *

QPI 12 (i): 90-day Mortality Following Oncological Treatment – Proportion of patients with gastric cancer who die within 90 days of curative oncological treatment. (a) Chemoradiotherapy

<7.5%

* * * * *

* * * * * * * * * *

QPI 12 (i): 30-day Mortality Following Oncological Treatment – Proportion of patients with gastric cancer who die within 30 days of curative oncological treatment. (b) Peri-operative chemotherapy

<5%

- - 0.0% = 0.0% = 0.0% =

- - - - 0 10 0 5 0 21

QPI 12 (i): 90-day Mortality Following Oncological Treatment – Proportion of patients with gastric cancer who die within 90 days of curative oncological treatment. (b) Peri-operative chemotherapy

<7.5%

- - 0.0% > 0.0% = 0.0% >

- - - - 0 10 0 5 0 20





QPI 12 (ii): 30-day Mortality Following Oncological Treatment – Proportion of patients with gastric cancer who die within 30 days of palliative oncological treatment.

(c) Chemotherapy

<5%

- - 4.5% < 14.3% = 6.1% >

- - - - 1 22 1 7 2 33

QPI 13: HER2 Status – Proportion of patients with metastatic gastric or gastro-oesophageal junction adenocarcinoma undergoing first line palliative chemotherapy as their initial treatment for whom the HER2 status is reported prior to commencing treatment.

90%

- - 90.5% 71.4% 88.2%

- - - - 19 21 5 7 30 34

Clinical Trials QPI – Oesophageal and gastric cancers

Upper GI Cancers Quality Performance Indicator (QPI)


QPI target AA FV GGC Lan WoS*

QPI 14: Clinical Trials Access - Proportion of patients diagnosed with Upper GI cancer who are consented for a clinical trial/research study.

15%

5.7% 6.3% 5.6% 2.0% 5.5%

6 106 5 80 21 375 3 152 39 714

*Includes 4 consented patients where Board of Residence was not recorded.


Conclusions Cancer audit has underpinned much of the regional development and service improvement work of the MCN and the regular reporting of activity and performance have been fundamental in assuring the quality of care delivered across the region. Following the development of QPIs, this has now become an established national programme to drive continuous improvement and ensure equity of care for patients across Scotland. West of Scotland Boards’ continued commitment to the improvement of the quality and completeness of audit data has provided accurate data for the reporting of performance against the Upper GI Cancer QPIs from which yearly comparisons in service provision across WoS Boards can be made. Analysis of the QPIs indicates that targets have been met by all Boards for post surgical mortality and longitudinal resection margins. Further improvement is required for nutritional assessment, recording of treatment intent at MDT and curative treatment rates. Where QPI targets were not met NHS Boards have provided detailed commentary. In the main these indicate valid clinical reasons, or that in some cases patient choice or co-morbidities have influenced patient management. Additionally, NHS Boards have indicated where positive action has already been taken at a local level to address any issues highlighted through the QPI data analysis. It is anticipated that these positive changes will result in improved performance going forward. Boards are asked to develop local Action/Improvement Plans in response to the findings presented in the report. A summary of actions has been included within the Action Plan templates in the Appendix. Actions required: QPI 4: Staging and Treatment Intent

NHS Lanarkshire to ensure that treatment intent is recorded at MDT for all patients where appropriate.

QPI 8: Lymph Node Yield

NHS Greater Glasgow and Clyde to provide detailed feedback for patients with oesophageal and gastric cancer who did not meet the target, and to identify barriers/strategies to improve performance.

NHS Lanarkshire to continue work to improve communication between surgical sites and central pathology department in order to maximise opportunities for fresh tissue analysis.

QPI 9: Length of Hospital Stay Following Surgery

NHS Lanarkshire will investigate sources of error in SMR01 data and provide results of local review of patients with oesophageal and gastric cancer to the MCN.

Completed Action Plans should be returned to WoSCAN within two months of publication of this report.

The MCN Advisory Board will actively monitor progress against changes implemented by NHS Boards, and any service issue the Advisory Board considers not to have been adequately addressed, will be escalated to the appropriate NHS Board Lead Cancer Clinician and the Regional Lead Cancer Clinician.


In addition, progress will be reported annually to the Regional Cancer Advisory Group (RCAG) by NHS Board Lead Cancer Clinicians and MCN Clinical Leads, and nationally on a three-yearly basis to Healthcare Improvement Scotland as part of the governance processes set out in CEL 06 (2012).


1. Introduction

This report presents an assessment of performance of West of Scotland Upper Gastro-intestinal (GI) Cancer Services relating to patients diagnosed in the region between 01 January 2017 and 31 December 2017. These audit data underpin much of the regional development/service improvement work of the Managed Clinical Network (MCN) and regular reporting of activity and performance is a fundamental requirement of an MCN to assure the quality of care delivered across the region. Data was measured against v3.0 of the Upper GI Cancer Quality Performance Indicators (QPIs)1. This was the fifth consecutive year of analysis following the initial Healthcare Improvement Scotland (HIS) publication of Upper GI cancer QPIs in 2012. This was part of a programme of work led by the National Cancer Quality Steering Group (NCQSG) to develop national measures in the form of QPIs for all cancer types, in collaboration with the three Regional Cancer Networks and Information Services Division (ISD). In order to ensure the success of the National Cancer QPIs in driving quality improvement in cancer care across NHS Scotland, a process of formal review was carried out after Year 3 of comparative reporting with tumour-specific Regional Clinical Leads undertaking a key role in determining the extent of the review required for each tumour type. The revised Upper GI Cancer QPIs1 were published in March 2017 and are valid for patients diagnosed on or after 01 January 2016. Annual comparisons have been made where indicators remain comparable following this formal review. Any new QPIs which were developed requiring new data items will be reported for the first time within this report (using year 5 data) as a year’s worth of data was required to be collected before the new items could be reported. Future reports will continue to compare clinical audit data in successive years to illustrate trends.

2. Background

Four NHS Boards across the WoS serve the 2.5 million population. There were 707 new cases of Upper GI cancer diagnosed in total in the West of Scotland (WoS) in 2017 (520 oesophageal, 187 gastric). The configuration of the Multidisciplinary Teams (MDTs) who manage and treat these patients across the region is set out below.

MDT Constituent Hospital(s) Ayrshire & Arran (AA) Crosshouse Hospital, Ayr Hospital Greater Glasgow and Clyde (GGC)

Royal Alexandra Hospital, Inverclyde Royal Hospital, Vale of Leven, Gartnavel General Hospital, Glasgow Royal Infirmary, Queen Elizabeth University Hospital (formerly Southern General), Victoria Infirmary

Forth Valley (FV) Forth Valley Royal Hospital Lanarkshire (Lan) Wishaw General Hospital, Monklands District General, Hairmyres

Patients from Forth Valley requiring major upper GI resection have their surgery in Glasgow Royal Infirmary. The Forth Valley surgeons are responsible for the local diagnosis, staging and follow up and are involved with the surgical resection in Glasgow. Analysis of the data contained within this report is based on the NHS Board responsible for treatment. Outcome measures regarding the quality of surgical services have been analysed based on the NHS Board where surgery was performed. Quality assurance and continuous service improvement will be supported by regular assessment of service performance against the nationally defined QPI criteria.


2.1 National context

Oesophageal cancer is the tenth most common cancer in Scotland with 858 cases diagnosed nationally in 20162. There has been a decrease in the incidence of oesophageal cancer from 2006 to 2016 of 6.4%2. Oesophageal cancer is more common in males with just over two thirds of cases occurring nationally in males in 2016 (ratio of 2:1). Gastric cancer is the thirteenth most common cancer in Scotland with 623 cases diagnosed nationally in 20163. The incidence of gastric cancer in Scotland has fallen significantly, with a 34.6% decrease in males and a 27.8% decrease in females between 2006 and 2016. As with oesophageal cancer, the ratio of male:female cases is approximately 2:1.

Overall cancer mortality rates have decreased by 13% in males and 7% in females in the last ten years4. The mortality rate for gastric cancer has seen the most significant decrease of any cancer type in both males and females, showing a 35.1% and 28.6% decrease in mortality rates respectively3. The mortality rate for oesophageal cancer has seen significant decreases in both males and females by 8.1% and 13.2% respectively2. However oesophageal cancer still remains the fourth most common cause of death from cancer in males and the sixth most common cause of death from cancer in females. Survival for oesophageal and gastric cancers is low compared to other cancers however relative 1-year and 5-year survival is increasing5.Table 1 shows the percentage change in 1-year and 5-year survival rates for patients diagnosed in 1987-1991 compared to those diagnosed in 2007-2011. Table 1: Relative age-standardised survival for oesophageal and gastric cancers in Scotland at 1 year and 5 years showing percentage change from 1987-1991 to 2007-2011

2

Relative survival at 1 year (%) Relative survival at 5 years (%)

2007-2011 % change 2007-2011 % change

Oesophageal cancer Male 41.8% + 17.7% 12.1% + 6.5%

Female 37.7% + 11.8% 12.7% + 4.6%

Gastric cancer Male 41.9% + 15.9% 15.4% + 5.3%

Female 40.3% + 14.4% 20.5% + 9.3%


2.2 West of Scotland context In 2017 there were 707 new cases of oesophagogastric cancer that were identified through audit as having been managed in the West of Scotland. The number managed through each MDT/NHS Board is presented in Figure 1 and broken down by the site of origin of the tumour. Figure 1: Number of patients diagnosed in 2017 with oesophageal or gastric cancer by NHS Board of diagnosis.

AA FV GGC Lan WoS

Oesophageal cancer 81 53 290 96 520

Gastric cancer 27 16 100 44 187

Total 108 69 390 140 707

Oesophagogastric cancers are more common in men than women. The disease is more common in older age groups with 59% of cases occurring in individuals 70 years old and over. Figure 2 shows the age and gender breakdown of oesophagogastric cancer within the WoS region in 2017.

0

50

100

150

200

250

300

AA FV GGC Lan

Nu

mb

er

of

Dia

gno

ses

NHS Board

Oesophageal Gastric


Figure 2: Number of patients diagnosed in 2017 with oesophageal or gastric cancer in WoS within each age group.

<45 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ All ages

Oesophageal Male 5 4 17 42 41 63 58 45 38 26 339

Female 3 3 3 13 14 24 30 30 30 31 181

<45 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ All ages

Gastric Male 1 4 3 9 7 9 19 24 17 14 107

Female 0 2 5 2 7 8 6 22 18 10 80

0

10

20

30

40

50

60

70

Under 45 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+

Oesophageal

Male Female

0

5

10

15

20

25

Under 45

45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+

Gastric

Male Female


Figure 3: Clinical stage at diagnosis for patients diagnosed with oesophageal and gastric cancer in WoS in 2017

Stage group T Stage N Stage M Stage Stage group T Stage N Stage M Stage

Stage IA T1 N0 M0 Stage IA T1 N0 M0

Stage IB T2 N0 M0 Stage IB

T2 N0 M0

Stage IIA T3 N0 M0 T1 N1 M0

Stage IIIA

T4a N0 M0

Stage IIA

T3 N0 M0

T3 N1 M0 T2 N1 M0

T1, T2 N2 M0 T1 N2 M0

Stage IIIB T3 N2 M0

Stage IIB

T4a N0 M0

Stage IIIC

T4a N1, N2 M0 T3 N1 M0

T4b Any N M0 T2 N2 M0

Any T N3 M0 T1 N3 M0

Stage IV Any T Any N M1

Stage IIIA

T4a N1 M0

T3 N2 M0

T2 N3 M0

Stage IIIB

T4b N0, N1 M0

T4a N2 M0

T3 N3 M0

Stage IIIC

T4a N3 M0

T4b N2, N3 M0

Stage IV Any T Any N M1

The audit dataset includes the Tumour, Nodal and Metastases (TNM) stage at diagnosis, which can be used to calculate an overall disease stage for each patient. This is done according to the TNM Classification of Malignant Tumours (7th Edition)6 and the tables in Figure 3 detail how stage is calculated from TNM for oesophageal and gastric cancers respectively. As it is not always specified whether T4 stage is T4a or T4b, stage groups are shown as Stage I, II, III or IV only as further breakdown by stage category is not always possible.

TNM Classification of Malignant Tumours (8th Edition) will be used as of next year’s reporting period i.e. for patients diagnosed from 1st January 2018 onwards.

Stage I, 10.6%

Stage II, 13.9%

Stage III, 22.8%

Stage IV, 43.1%

Not Recorded,

3.5%

Not assessable,

6%

Other, 9.5%

Other, 6.5

Oesophageal

Stage I8.5%

Stage II12.3%

Stage III9.1%

Stage IV56.2%

Not Recorded4.8%

Not assessable8.0%

Null values1.1%

Other9.1%

Gastric


3. Methodology

The clinical audit data presented in this report were collected by clinical audit staff in each NHS Board in accordance with an agreed dataset and definitions. Data were recorded manually and entered locally into the electronic Cancer Audit Support Environment (eCASE): a secure centralised web-based database. Data relating to patients diagnosed between 01 January 2017 and 31 December 2017 were downloaded from eCASE at 2200 hrs on 04 July 2018. Cancer audit is a dynamic process with patient data continually being revised and updated as more information becomes available. This means that apparently comparable reports for the same time period and cancer site may produce different figures if extracted at different times. Analysis was performed centrally for the region by the WoSCAN Information Team and the timescales agreed took into account the patient pathway to ensure that a complete treatment record was available for each case. Initial results of the analysis were provided to local Boards to check for inaccuracies, inconsistencies or obvious gaps and a subsequent download taken upon which final analysis was carried out. The final data analysis was disseminated for NHS Board verification in line with the regional audit governance process to ensure that their data were an accurate representation of service in each area.


4. Results

4.1 Data quality

Audit data quality can be assessed in the first instance by estimating the proportion of expected patients that have been identified through audit. Case ascertainment is calculated by the number of patients identified by the audit as a proportion of the number of cases reported by the National Cancer Registry (provided by ISD, National Services Scotland). Cancer Registry figures used were extracted from ACaDMe (Acute Cancer Deaths and Mental Health) on 13 June 2018 via the standard reports available and are an average of the previous 5 years’ figures to take account of annual fluctuations in incidence within NHS Boards. The overall case ascertainment in WoSCAN is 99.0% which indicates excellent data capture for 2017 and overall WoS results should therefore be an accurate reflection of performance in the region. Figure 3 illustrates estimated case ascertainment across the WoS NHS Boards and varies from 86.3% in NHS Forth Valley to 104.0% in NHS Greater Glasgow and Clyde. Case ascertainment figures are provided for guidance and are not an exact measurement as it is not possible to compare directly with the same cohort.

Figure 4: Estimated case ascertainment by Board for patients diagnosed with oesophagogastric cancers in 2017.

AA FV GGC Lan WoS

Cases from 2017 audit 108 69 390 140 707

ISD Cases (2011-2015 average) 106 80 375 152 714

% Case ascertainment 101.9% 86.3% 104.0% 92.1% 99.0%

0

20

40

60

80

100

120

AA FV GGC LS WoS

Cas

e A

sce

rtai

nm

en

t %

NHS Board


4.2 Performance against Quality Performance Indicators

Results of the analysis of Upper GI Cancer QPIs are set out in the following sections. Graphs and charts have been provided where this aids interpretation and, where appropriate, numbers have also been included to provide context. Each QPI displays first the performance in oesophageal cancer and then the same for gastric cancer. Where possible, and with consideration given to any changes after formal review, results for patients diagnosed in Year 5 have been presented alongside the previous years’ results to illustrate trends. Data (both graphically and in tabular format) are presented by location of diagnosis or location of treatment with some criteria given as an overall West of Scotland representation. Boards have already reviewed cases where targets have not been met, and the detailed clinical commentary provided by Boards is noted beside each measure along with details of any specific changes that have already been implemented to address issues highlighted through the analysis. Where the number of cases meeting the denominator criteria for any indicator is between one and four, the percentage calculation has not been shown on any associated charts or tables. This is to avoid any unwarranted variation associated with small numbers and to minimise the risk of disclosure. Any charts or tables impacted by this are denoted with a dash (-). Any commentary provided by NHS Boards relating to the impacted indicators will however be included as a record of continuous improvement. An asterisk (*) is applied to indicate a denominator of zero and to distinguish between this and a 0% performance.


QPI 1: Biopsy Procedure For diagnosis of oesophageal and gastric cancer the use of endoscopy is recommended. A tissue diagnosis in cases of suspected oesophageal and gastric cancer requires adequate sampling of the suspicious lesion. Multiple biopsies should be obtained and the number of biopsies examined should always be reported1. The tolerance within the 95% target is designed to account for factors of patient choice.

QPI 1: Patients with oesophageal or gastric cancer should undergo endoscopy and biopsy to reach a diagnosis of cancer.

Numerator: Number of patients with oesophageal or gastric cancer who undergo endoscopy who have a histological diagnosis made within 6 weeks of initial endoscopy and biopsy.

Denominator: All patients with oesophageal or gastric cancer who undergo endoscopy.

Exclusions: No exclusions.

Target: 95%

Due to changes at formal review, data is only shown for 2016 and 2017. Figure 5: The proportion of patients with oesophageal cancer who underwent endoscopy that had a histological diagnosis made within 6 weeks of initial endoscopy and biopsy.

QPI 1 Performance (%) Numerator Denominator Not recorded

numerator Not recorded exclusions

Not recorded denominator

AA 89.9% 71 79 0 0 0

FV 100.0% 52 52 0 0 0

GGC 92.7% 267 288 0 0 0

Lan 100.0% 95 95 0 0 0

WoS 94.4% 485 514 0 0 0

NHS Forth Valley and NHS Lanarkshire met the 95% target, both with 100.0%. NHS Ayrshire and Arran and NHS Greater Glasgow and Clyde were short of the target with 89.9% and 92.7% respectively. Improvement has been shown this year by all Boards within the WoS. The overall WoS performance was 94.4%. Boards have reviewed cases not meeting the target and provided feedback. A number of reasons were highlighted for patients not meeting the target including: diagnosis made clinically and therefore pathology not pursued; biopsy indicative of dysplastic pathology or “suspicion of malignancy”. In a small number of cases an inadequate biopsy sample was taken. NHS Ayrshire

0

10

20

30

40

50

60

70

80

90

100

AA FV GGC LAN WoS

Pe

rfo

rman

ce (

%)

NHS Board

Oesophageal

2016 2017 QPI Target


and Arran have noted that there is a continued pressure on endoscopy and pathology waiting times. Figure 6: The proportion of patients with gastric cancer who underwent endoscopy that had a histological diagnosis made within 6 weeks of initial endoscopy and biopsy.




AA 87.5% 21 24 0 0 0

FV 100.0% 14 14 0 0 0

GGC 84.2% 80 95 0 0 0

Lan 89.2% 33 37 0 0 0

WoS 87.1% 148 170 0 0 0

NHS Forth Valley was the only Board to meet the 95% target with 100.0% for the second consecutive year. All Boards not meeting the target showed a reduction in performance on the previous year. The overall performance for the WoS was 87.1%.

Boards have reviewed cases not meeting the target and provided feedback. In a number of cases, initial biopsies showed high grade dysplasia or no evidence of malignancy. In small number of cases biopsy samples were inadequate, or no sample was taken due to concurrent anticoagulant therapy.

NHS Greater Glasgow and Clyde and NHS Lanarkshire will continue to improve the quality of biopsy sampling and reporting, and will enforce the need of this to relevant staff.

0

10

20

30

40

50

60

70

80

90

100

AA FV GGC LAN WoS

Pe

rfo

rman

ce (

%)

NHS Board

Gastric



QPI 3: MDT Discussion

Evidence suggests that patients with cancer managed by a multi-disciplinary team achieve better outcomes. There is also evidence that the multidisciplinary management of patients increases their overall satisfaction with their care1. Discussion prior to definitive treatment decisions being made provides reassurance that patients are being managed appropriately1. The tolerance within this QPI accounts for situations where patients require surgery or other intervention urgently.

QPI 3: Patients should be discussed by a multidisciplinary team prior to definitive treatment.

Numerator: Number of patients with oesophageal or gastric cancer discussed at the MDT before definitive treatment.

Denominator: All patients with oesophageal and gastric cancer.

Exclusions: Patients who died before first treatment.

Target: 95%

Figure 7: The proportion of patients with oesophageal cancer who were discussed at the MDT meeting before definitive treatment.




AA 94.8% 73 77 0 0 0

FV 96.2% 51 53 0 0 0

GGC 96.9% 277 286 0 0 0

Lan 91.4% 85 93 0 0 0

WoS 95.5% 486 509 0 0 0

NHS Forth Valley and NHS Greater Glasgow and Clyde both met the 95% target with 96.2% and 96.9% respectively. NHS Lanarkshire was short of the target with 91.4% and NHS Ayrshire and Arran was marginally short with 94.8%. Overall the WoS met the target with 95.5%. NHS Ayrshire and Arran noted that all patients not meeting the target underwent endoscopic treatment prior to MDT. The Board concluded that this was the appropriate treatment for these patients. NHS Lanarkshire stated that a number of patients received endoscopic treatment prior to MDT. It was identified that two patients had been miscoded and should have made the target. This error has since been rectified. One patient was not discussed at MDT. The Board concluded that all cases were managed appropriately.

0

10

20

30

40

50

60

70

80

90

100

AA FV GGC LAN WoS

Pe

rfo

rman

ce (

%)

NHS Board

Oesophageal

2014 2015 2016 2017 QPI Target


Figure 8: The proportion of patients with gastric cancer who were discussed at the MDT meeting before definitive treatment.




AA 91.3% 21 23 0 0 0

FV 100.0% 14 14 0 0 0

GGC 93.9% 93 99 0 0 0

Lan 78.6% 33 42 0 0 0

WoS 90.4% 161 178 0 0 0

NHS Forth Valley was the only Board to meet the 95% target with a performance of 100.0%. NHS Lanarkshire was significantly short of the target with 78.6%. NHS Ayrshire and Arran and NHS Greater Glasgow and Clyde achieved 91.3% and 93.9% respectively. All Boards failing the target showed a reduction in performance on the previous year. The overall WoS performance was 90.4%.

Boards have reviewed cases not meeting the target and provided feedback. A number of patients received treatment, e.g. stenting prior to MDT which was clinically appropriate in the situation. Other reasons included emergency surgery and patients dying prior to MDT discussion. NHS Lanarkshire identified one case which had been miscoded, which has now been rectified.

0

10

20

30

40

50

60

70

80

90

100

AA FV GGC LAN WoS

Pe

rfo

rman

ce (

%)

NHS Board

Gastric

2014 2015 2016 2017 QPI Target


QPI 4: Staging and Treatment Intent Patients with gastric or oesophageal cancer should undergo careful staging to assess the extent of disease and inform treatment decision making1. Clinical staging should follow the principles of TNM classification; this aids the determination of prognosis and choice of therapy. A statement regarding clinical stage and treatment intent should be recorded at the MDT meeting. For patients presenting with metastatic disease it is not always possible or appropriate to determine T and N stage. Within the QPI TxNxM1 is therefore accepted as complete staging in this situation1. Following formal review the specifications of this QPI were separated to ensure clear measurement of patients who have the following recorded at MDT meeting prior to treatment : (i) TNM stage; and (ii) Treatment Intent

QPI 4(i): Patients with oesophageal or gastric cancer should be staged using the TNM staging system and have this recorded at MDT prior to treatment commencing.

Numerator: Number of patients with oesophageal or gastric cancer who have TNM stage recorded at MDT prior to treatment.



Target: 90%

Figure 9: The proportion of patients with oesophageal cancer who had TNM stage recorded at MDT prior to treatment.

QPI 4(i) Performance (%) Numerator Denominator Not recorded



AA 97.5% 79 81 0 0 0

FV 98.1% 52 53 0 0 0

GGC 90.3% 262 290 0 0 0

Lan 94.8% 91 96 0 0 0

WoS 93.1% 484 520 0 0 0

All Boards within the WoS met the 90% target. The overall regional performance for the WoS was 93.1% with 484 out of 520 patients having TNM staging recorded at MDT prior to treatment.

0

10

20

30

40

50

60

70

80

90

100

AA FV GGC LAN WoS

Pe

rfo

rman

ce (

%)

NHS Board

Oesophageal



Figure 10: The proportion of patients with gastric cancer who had TNM stage recorded at MDT prior to treatment.




AA 100.0% 27 27 0 0 0

FV 100.0% 16 16 0 0 0

GGC 85.0% 85 100 0 0 0

Lan 97.7% 43 44 0 0 0

WoS 91.4% 171 187 0 0 0

NHS Ayrshire and Arran, NHS Forth Valley and NHS Lanarkshire all met the 90% target, with NHS Ayrshire and Arran and NHS Forth Valley achieving 100.0% for the second consecutive year. NHS Greater Glasgow and Clyde fell short of the target with 85.0%. The overall performance for the WoS met the target at 91.4% but was down on the previous year’s performance. NHS Greater Glasgow and Clyde have reviewed cases not meeting the target. The majority of cases were not referred to MDT due to advanced disease and inappropriateness of staging. A small number of patients received palliative laser therapy prior to MDT discussion. NHS Greater Glasgow and Clyde highlighted the need for improved MDT documentation and software. Regional work continues around the investigation into the delivery of a MDT system that will support local NHSGGC and regional and national MDTs that are hosted by NHSGGC.

0

10

20

30

40

50

60

70

80

90

100

AA FV GGC LAN WoS

Pe

rfo

rman

ce (

%)

NHS Board

Gastric



QPI 4(ii): Patients with oesophageal or gastric cancer should have treatment intent recorded at MDT prior to treatment commencing.

Numerator: Number of patients with oesophageal or gastric cancer who treatment intent recorded at MDT prior to treatment.



Target: 95%

Figure 11: The proportion of patients with oesophageal cancer who have treatment intent recorded at MDT prior to treatment.

QPI 4(ii) Performance (%) Numerator Denominator Not recorded



AA 98.8% 80 81 0 0 0

FV 100.0% 53 53 0 0 0

GGC 84.8% 246 290 0 0 0

Lan 94.8% 91 96 0 0 0

WoS 90.4% 470 520 0 0 0

NHS Ayrshire and Arran and NHS Forth Valley met the 95% target. NHS Greater Glasgow and Clyde was short of the target with 84.8%, while NHS Lanarkshire was marginally short with 94.8%. The overall WoS result was below target at 90.4%, which is a reduction in performance on the previous year.

NHS Greater Glasgow and Clyde and NHS Lanarkshire have provided feedback on cases not meeting the target. A number of patients received appropriate treatment prior to MDT. Other reasons included patient death prior to MDT, patient fitness for further staging and patients refusing treatment. NHS Lanarkshire identified a small number of patients who were not discussed at MDT or did not have treatment intent recorded at MDT.

0

10

20

30

40

50

60

70

80

90

100

AA FV GGC LAN WoS

Pe

rfo

rman

ce (

%)

NHS Board

Oesophageal



Figure 12: The proportion of patients with gastric cancer who have treatment intent recorded at MDT prior to treatment.




AA 92.6% 25 27 0 0 0

FV 87.5% 14 16 0 0 0

GGC 89.0% 89 100 0 0 0

Lan 88.6% 39 44 0 0 0

WoS 89.3% 167 187 0 0 0

No Board within the WoS met the 95% target, with all Boards showing a reduction in performance on the previous year. The overall performance for the WoS was 89.3%.

NHS Ayrshire and Arran, NHS Forth Valley and NHS Lanarkshire provided feedback on cases not meeting the target. In the majority of cases the patient died prior to MDT. In other cases the patient was not discussed or had refused treatment.

NHS Greater Glasgow and Clyde stated that the performance was due to a MDT documentation issue.

Actions:


0

10

20

30

40

50

60

70

80

90

100

AA FV GGC LAN WoS

Pe

rfo

rman

ce (

%)

NHS Board

Gastric



QPI 5: Nutritional Assessment All patients with oesophageal or gastric cancer should be screened using a validated screening tool to assess nutritional risk. Those at risk of nutritional problems should have access to a state registered dietitian to provide appropriate advice1. Poor nutritional status is a risk factor for poor tolerance of treatment and can impact greatly on quality of life. Appropriate nutritional support can help reduce complications such as sepsis, poor wound healing and reduce length of stay1. At formal review, this QPI was split into two parts. Part (i) measures patients screened using the Malnutrition Universal Screening Tool (MUST). Part (ii) measures high risk patients referred to a dietician. As these changes required new data fields, these QPIs could not be reported on last year and are reported for this first time for this audit period.

QPI 5(i): Patients with oesophageal or gastric cancer should be appropriately assessed by a dietitian to optimise nutritional status.

Numerator: Number of patients with oesophageal or gastric cancer who undergo nutritional screening with the MUST before first treatment.



Target: 95%

Figure 13: The proportion of patients with oesophageal cancer who undergo nutritional screening with the MUST before treatment.




AA 60.0% 48 80 0 0 0

FV 67.9% 36 53 1 0 0

GGC 81.0% 235 290 0 0 0

Lan 26.0% 25 96 19 0 0

WoS 66.3% 344 519 20 0 0

No Board within the WoS met the 95% target. The highest performance was in NHS Greater Glasgow and Clyde with 81.0%. The lowest performance was in NHS Lanarkshire with 26.0%. The overall performance for the WoS was 66.3%. NHS Ayrshire and Arran stated that the majority of cases either had assessment once treatment had begun or were not deemed appropriate for dietetic screening. In a small number of cases patients were referred to dietetics but were not seen. A few patients declined dietetic services.

0

10

20

30

40

50

60

70

80

90

100

AA FV GGC Lan WoS

Pe

rfo

rman

ce (

%)

NHS Board

Oesophageal

2017 QPI Target


NHS Ayrshire and Arran commented that MUST scoring is not prioritised for patients who are eating normally with a stable weight. NHS Forth Valley stated that it is felt that not all patients require dietetic screening prior to first treatment. It is noted that there is a local lack of funding and availability for dietetic services. NHS Greater Glasgow and Clyde noted that there has been an improvement in documentation in this area. Efforts will be made to improve documentation in the future. NHS Lanarkshire commented that it is felt that the QPI result does not reflect actual performance. On review the Board states that 83% of patients with upper GI malignancy were reviewed by a dietician. The document for recording MUST is now being routinely scanned onto clinical portal to improve collection of this data for audit purposes. Figure 14: The proportion of patients with gastric cancer who undergo nutritional screening with the MUST before treatment.




AA 48.1% 13 27 0 0 0

FV 68.8% 11 16 0 0 0

GGC 84.0% 84 100 0 0 0

Lan 11.4% 5 44 13 0 0

WoS 60.4% 113 187 13 0 0

No Boards within the WoS met the 95% target. The highest performance was 84.0% in NHS Greater Glasgow and Clyde with the lowest performance of 11.4% in NHS Lanarkshire. The overall performance for the WoS was 60.4%. Feedback from Boards reflects the comments made previously for patients with oesophageal cancer.

0

10

20

30

40

50

60

70

80

90

100

AA FV GGC Lan WoS

Pe

rfo

rman

ce (

%)

NHS Board

Gastric

2017 QPI Target


QPI 5(ii): Patients with oesophageal or gastric cancer should be appropriately assessed by a dietitian to optimise nutritional status.

Numerator: Number of patients with oesophageal or gastric cancer at high risk of malnutrition (MUST score of 2 or more) who are referred to a dietitian.

Denominator: All patients with oesophageal and gastric cancer at high risk of malnutrition (MUST score of 2 or more).


Target: 90%

Figure 15: The proportion of patients with oesophageal cancer at high risk of malnutrition who are referred to a dietician.




AA 100.0% 24 24 0 0 2

FV 100.0% 23 23 0 0 2

GGC 95.7% 89 93 0 0 0

Lan 100.0% 13 13 0 0 19

WoS 97.4% 149 153 0 0 23

All Boards within the WoS met the 90% target, with NHS Ayrshire and Arran, NHS Forth Valley and NHS Lanarkshire all achieving a performance of 100.0%. The overall performance for the WoS was 97.4%.

0

10

20

30

40

50

60

70

80

90

100

AA FV GGC Lan WoS

Pe

rfo

rman

ce (

%)

NHS Board

Oesophageal

2017 QPI Target


Figure 16: The proportion of patients with gastric cancer at high risk of malnutrition who are referred to a dietitian.




AA 85.7% 6 7 0 0 2

FV 100.0% 8 8 0 0 1

GGC 89.3% 25 28 0 0 0

Lan - - - 0 0 13

WoS 91.5% 43 47 0 0 16 - Denominator is less than 5; percentages should be viewed with caution.

NHS Forth Valley and NHS Lanarkshire both met the 90% target, although the result for NHS Lanarkshire is not shown due to small numbers. NHS Ayrshire and Arran and NHS Greater Glasgow and Clyde fell short of the target with 85.7% and 89.3% respectively. The overall performance for the WoS was 91.5%. NHS Ayrshire and Arran commented that the patient not meeting the target had refused dietetic services. NHS Greater Glasgow and Clyde did not provide feedback on cases not meeting the target. Actions:

NHS Greater Glasgow and Clyde to review cases not meeting the target and provide feedback to the MCN.

0

10

20

30

40

50

60

70

80

90

100

AA FV GGC Lan WoS

Pe

rfo

rman

ce (

%)

NHS Board

Gastric

2017 QPI Target

-


QPI 6: Appropriate Selection of Surgical Patients Patients with oesophageal or gastric cancer who are suitable for surgical resection should be offered treatment with neoadjuvant chemotherapy or chemoradiotherapy. Neoadjuvant chemotherapy or chemoradiotherapy prior to surgery provides a survival benefit for patients with oesophageal and gastric cancer. These patients should proceed to curative resectional surgery; however a number of reasons may affect this e.g. initial understaging of disease1. At the formal review meeting it was agreed that it was also appropriate to include patients receiving neo-adjuvant chemoradiotherapy within this indicator. As new data codes were required, the data was presented last year using the pre-formal review measurability. Data is presented using the new measurability and treatment code for the first time this year. However, no patients involved in the analysis of this QPI received neoadjuvant chemoradiotherapy in Year 5. Therefore this year’s data remains comparable with that of previous years.

QPI 6: Patients with oesophageal or gastric cancer whose treatment plan is neoadjuvant chemotherapy or chemoradiotherapy followed by surgery should progress to surgery following completion of this treatment.

Numerator: Number of patients with oesophageal or gastric cancer who receive neoadjuvant chemotherapy or chemoradiotherapy who then undergo surgical resection.

Denominator: All patients with oesophageal or gastric cancer who receive neoadjuvant chemotherapy or chemoradiotherapy.


Target: 80%

Figure 17: The proportion of patients with oesophageal cancer who received neoadjuvant chemotherapy or chemoradiotherapy who then underwent surgical resection.




AA 60.0% 6 10 0 0 0

FV 42.9% 3 7 0 0 0

GGC 60.0% 21 35 1 0 0

Lan 66.7% 8 12 0 0 0

WoS 59.4% 38 64 1 0 0

No Boards within the WoS met the 80% target. The best performance was in NHS Lanarkshire with 66.7% and the lowest performance was in NHS Forth Valley with 42.9%. The overall performance for the WoS was 59.4%.

0

10

20

30

40

50

60

70

80

90

100

AA FV GGC LAN WoS

Pe

rfo

rman

ce (

%)

NHS Board

Oesophageal

2014 2015 2016 2017 QPI Target

- -


Boards have reviewed cases not meeting the target and provided feedback. Reasons including disease progression, concurrent illness, patient suitability for surgery and patient choice were noted. Cases have been reviewed locally and were deemed to have been managed appropriately. Figure 18: The proportion of patients with gastric cancer who received neoadjuvant chemotherapy or chemoradiotherapy who then underwent surgical resection.




AA - - - 0 0 0

FV - - - 0 0 0

GGC 75.0% 6 8 0 0 0

Lan 60.0% 3 5 1 0 0


NHS Greater Glasgow and Clyde and NHS Lanarkshire did not meet the 80% target with 75.0% and 60.0% respectively. NHS Ayrshire and Arran and NHS Forth Valley met the target but data is not shown due to small numbers. The overall performance for the WoS was below target at 75.0%. NHS Lanarkshire have reviewed cases not meeting the target and provided feedback. All patients were managed in a clinically appropriate manner. NHS Greater Glasgow and Clyde cited the unpredictability of patient responses to neo-adjuvant chemotherapy as a contributing factor.

0

10

20

30

40

50

60

70

80

90

100

AA FV GGC LAN WoS

Pe

rfo

rman

ce (

%)

NHS Board

Gastric

2014 2015 2016 2017 QPI Target

- - - - - -


QPI 7: 30/90-day Mortality Following Surgery Treatment related mortality is a marker of the quality and safety of the whole service provided by the Multi Disciplinary Team (MDT). Treatment should only be undertaken in individuals that may benefit from treatment, that is, disease specific treatments should not be undertaken in futile situations. This QPI is intended to ensure treatment is given appropriately1. At formal review the 30 day target was increased from 10% to 5%. The 90 day target was increased from 10% to 7.5%.

QPI 7: 30 and 90-day mortality following surgical resection for oesophageal or gastric cancer.

Numerator: Number of patients with oesophageal or gastric cancer who undergo surgical resection who die within 30 or 90 days of treatment.

Denominator: All patients with oesophageal or gastric cancer who undergo surgical resection.


Target: 30 day: < 5%

90 day: <7.5%

Within the WoS, there were no deaths at 30 or 90 days following surgical resection for oesophageal or gastric cancer. This is an improvement on last year’s performance where the 30 and 90 day mortality for patients with oesophageal cancer in the WoS was 4.8% and 10.2% respectively; while the 30 and 90 day mortality for patients with gastric cancer in the WoS was 3.1% and 3.6% respectively. Measures were taken after last year’s audit to improve patient selection for surgical resection. Within Greater Glasgow and Clyde a “high risk” clinic was instituted to assess cases where a number of comorbidities had been identified. The fitness threshold for major surgery has also been readdressed.


QPI 8: Lymph Node Yield Maximising the number of lymph nodes resected and analysed enables reliable staging which influences treatment decision making. Evidence recommends that at least 15 lymph nodes are resected and examined by a pathologist1. Initially when published this QPI measured lymph node yield in patients undergoing surgical resection for gastric cancer only. During the formal review process QPI 8 was updated to include measurement of lymph node yield in patients undergoing surgery for oesophageal cancer also. Therefore figure 19 only offers comparison against one previous year where data allows. The tolerance within the QPI target accounts for situations where patients are not fit enough to undergo extensive lymphadenectomy and for situations where surgical resection is performed for palliation1.

QPI 8: For patients with oesophageal or gastric cancer undergoing curative resection the number of lymph nodes examined should be maximised.

Numerator: Number of patients with oesophageal or gastric cancer who undergo surgical resection where ≥15 lymph nodes are resected and pathologically examined.



Target: Oesophageal - 90% Gastric - 80%

Figure 19: The proportion of patients with oesophageal cancer who underwent curative surgical resection where ≥15 lymph nodes were resected and pathologically examined.




AA 100.0% 6 6 0 0 0

FV * * * 0 0 0

GGC 70.4% 19 27 0 0 0

Lan 50.0% 4 8 0 0 0

WoS 70.7% 29 41 0 0 0 * Denominator is zero

NHS Ayrshire and Arran met the 90% target with a performance of 100.0%. NHS Greater Glasgow and Clyde and NHS Lanarkshire both fell short of the target with 70.4% and 50.0% respectively. Both of these performances were down on the previous year. The overall performance for the WoS was below the target at 70.7%.

0

10

20

30

40

50

60

70

80

90

100

AA FV GGC LAN WoS

Pe

rfo

rman

ce (

%)

NHS Board

Oesophageal


- * *


NHS Lanarkshire reviewed all cases not meeting the target and provided feedback, recent centralisation of the pathology department to Monklands hospital has made the provision of fresh specimens and liaising with the department more challenging. The practice of two consultant operating will continue to be utilised in order to optimise surgical outcomes. NHS Greater Glasgow and Clyde commented that variation in nodal yield may represent pathological assessment or patient/surgical variation. Figure 20: The proportion of patients with gastric cancer who underwent curative surgical resection where ≥15 lymph nodes were resected and pathologically examined.




AA - - - 0 0 0

FV * * * 0 0 0

GGC 77.8% 7 9 0 0 0

Lan 75.0% 6 8 0 0 0

WoS 77.8% 14 18 0 0 0 - Denominator is less than 5; * denominator is zero; percentages should be viewed with caution.

NHS Greater Glasgow and Clyde and NHS Lanarkshire fell short of the 80.0% target with 77.8% and 75.0% respectively. The performance for NHS Ayrshire and Arran is not shown due to small numbers. The overall performance for the WoS was 77.8%. The NHS Greater Glasgow and Clyde and WoS results show improvement on last year. The feedback for NHS Greater Glasgow and Clyde and NHS Lanarkshire gave similar reasoning as with the feedback for oesophageal cancer pathology above. Actions:



0

10

20

30

40

50

60

70

80

90

100

AA FV GGC LAN WoS

Pe

rfo

rman

ce (

%)

NHS Board

Gastric

2014 2015 2016 2017 QPI Target

- * * * -


QPI 9: Length of Hospital Stay Following Surgery Length of hospital stay acts as a surrogate measure for the quality of surgery and post-operative care for patients undergoing surgical resection for oesophagogastric cancer1. This QPI is intended as a surrogate marker to address various issues of quality care including surgery, post-operative complications, and access to community services. SMR01 data provided by ISD is utilised for measurement of QPI 9. Following discussion at the formal review meeting it was agreed to reduce the maximum length of stay within the criteria from 21 days to 14 days.

QPI 9: Length of hospital stay following surgery for oesophageal or gastric cancer should be as short as possible.

Numerator: Number of patients undergoing surgical resection for oesophageal or gastric cancer who are discharged within 14 days of surgical procedure.

Denominator: All patients undergoing surgical resection for oesophageal or gastric cancer.


Target: 60%

Figure 21: The proportion of patients who underwent surgical resection for oesophageal cancer who were discharged within 14 days of surgical procedure.




AA 71.4% 5 7 0 0 0

FV * * * 0 0 0

GGC 59.4% 19 32 0 0 0

Lan 33.3% 5 15 0 0 0

WoS 53.7% 29 54 0 0 0

* denominator is zero

NHS Ayrshire and Arran met the 60.0% target with a performance of 71.4%. NHS Lanarkshire was short of the target with 33.3%. NHS Greater Glasgow and Clyde were marginally short of the target with 59.4%. The overall performance for the WoS was 53.7%. NHS Greater Glasgow and Clyde commented that whilst this shows a marginal fail, it reflects the comorbid patient population. The introduction of the enhanced recovery pathway pilot within Glasgow Royal Infirmary at the beginning of 2018 is expected to lead to performance improvement.

0

10

20

30

40

50

60

70

80

90

100

AA FV GGC LAN WoS

Pe

rfo

rman

ce (

%)

NHS Board

Oesophageal


* *


NHS Lanarkshire stated that local audit analysis yielded different results to the SMR01 data used for this QPI. The Board will conduct further analysis locally to investigate this issue. Figure 22: The proportion of patients who underwent surgical resection for gastric cancer who were discharged within 14 days of surgical procedure.




AA - - - 0 0 0

FV * * * 0 0 0

GGC 89.5% 17 19 0 0 0

Lan 44.4% 4 9 0 0 0


NHS Greater Glasgow and Clyde met the 60% target with a performance of 89.5%. NHS Lanarkshire was short of the target with 44.4%. The result for NHS Ayrshire and Arran is not shown due to small numbers. The overall regional performance met the target with 76.7%. NHS Lanarkshire feedback again highlighted discrepancies between SMR01 data and that of local review. Further local analysis will be conducted by the Board. Actions:


0

10

20

30

40

50

60

70

80

90

100

AA FV GGC LAN WoS

Pe

rfo

rman

ce (

%)

NHS Board

Gastric


- - * *


QPI 10: Resection Margins Tumour involvement of surgical resection margins following excision is a negative prognostic factor; therefore surgeons should aim to ensure resection margins are clear of tumour1. QPI 10 (i) previously incorporated circumferential and longitudinal margins. Following formal review it was agreed to measure clear circumferential margin only and the QPI has been updated accordingly. In this instance comparison with previous years’ results was able to be reported due to local analysis being undertaken for this measure. QPI 10 (ii) remains unchanged.

QPI 10 (i): Oesophageal cancers which are surgically resected should be adequately excised.

Numerator: Number of patients with oesophageal cancer who undergo surgical resection in which circumferential surgical margin is clear of tumour.

Denominator: All patients with oesophageal cancer who undergo surgical resection.


Target: 70%

Figure 23: The proportion of patients with oesophageal cancer who underwent surgical resection in which circumferential surgical margins were clear of tumour.

QPI 10(i) Performance (%) Numerator Denominator

Not recorded numerator

Not recorded exclusions


AA 33.3% 2 6 0 0 0

FV * * * 0 0 0

GGC 74.1% 20 27 0 0 0

Lan 50.0% 4 8 0 0 0

WoS 63.4% 26 41 0 0 0 * Denominator is zero; percentages should be viewed with caution.

NHS Greater Glasgow and Clyde met the 70% target with a performance of 74.1%. NHS Ayrshire and Arran and NHS Lanarkshire both fell short of the target with 33.3% and 50.0% respectively. Boards have reviewed cases not meeting the target and provided detailed feedback. NHS Ayrshire and Arran stated that in all cases the actual margin was clear of tumour and maximal tissue had been taken. NHS Lanarkshire commented that due to the late presentation of disease and the desire to offer curative treatment where patients are fit with no clear evidence of disease out with the resection field on staging investigations, this QPI remains difficult to achieve. Locally, NHS Lanarkshire will

0

10

20

30

40

50

60

70

80

90

100

AA FV GGC LAN WoS

Pe

rfo

rman

ce (

%)

NHS Board

Oesophageal

2014 2015 2016 2017 QPI Target

- - - * * * *


continue to be critical when reviewing staging investigations to ensure under-staging does not occur.

QPI 10 (ii): Oesophageal and gastric cancers which are surgically resected should be adequately excised.

Numerator: Number of patients with oesophageal or gastric cancer who undergo surgical resection in which longitudinal surgical margin is clear of tumour.



Target: 90%

Figure 24: The proportion of patients with oesophageal cancer who underwent surgical resection in which longitudinal surgical margin was clear of tumour.

QPI 10(ii) Performance (%) Numerator Denominator




AA 100.0% 6 6 0 0 0

FV * * * 0 0 0

GGC 100.0% 27 27 0 0 0

Lan 100.0% 8 8 0 0 0

WoS 100.0% 41 41 0 0 0 * denominator is zero

Overall in the WoS 41/41 patients with oesophageal cancer undergoing surgical resection had clear longitudinal margins. This 100.0% performance meets the 90% target and is an improvement on the 96.8% performance from the previous year.

0

10

20

30

40

50

60

70

80

90

100

AA FV GGC LAN WoS

Pe

rfo

rman

ce (

%)

NHS Board

Oesophageal

2014 2015 2016 2017 QPI Target

- - - * * * *


Figure 25: The proportion of patients with gastric cancer who underwent surgical resection in which longitudinal surgical margin was clear of tumour.

QPI 10(ii) Performance (%) Numerator Denominator




AA - - - 0 0 0

FV * * * 0 0 0

GGC 92.9% 13 14 0 0 0

Lan 100.0% 9 9 0 0 0


In the WoS, 23/24 patients with gastric cancer undergoing surgical resection had clear longitudinal margins. The performance for NHS Ayrshire and Arran is not shown due to small numbers. The overall performance of 95.8% meets the 90% target.

0

10

20

30

40

50

60

70

80

90

100

AA FV GGC LAN WoS

Pe

rfo

rman

ce(%

)

NHS Board

Gastric

2014 2015 2016 2017 QPI Target

- * * * *


QPI 11: Curative Treatment Rates Surgical resection of the tumour remains the mainstay of curative treatment for patients with oesophageal or gastric cancer1. However in those patients with oesophageal cancer who have locally advanced disease, are unfit for surgery, or decline surgery, chemoradiotherapy should be considered. Radiotherapy alone is also an option in patients considered unsuitable for combination therapy but is rarely curative for oesophageal cancer. The tolerance within the target takes account for patient choice, fitness and comorbidities which preclude curative treatment. It is recognised that the majority of patients will have advanced disease at presentation.

QPI 11: Patients with oesophageal or gastric cancer should undergo curative treatment whenever possible.

Numerator: Number of patients with oesophageal or gastric cancer who undergo curative treatment.

Neoadjuvant chemoradiotherapy or chemotherapy followed by surgery;

Primary surgery;

Radical chemoradiotherapy; and

Endoscopic Mucosal Resection

Denominator: All patients with oesophageal or gastric cancer.


Target: 35%

Figure 26: The proportion of patients with oesophageal cancer who underwent curative treatment.




AA 21.5% 17 79 0 0 0

FV 26.0% 13 50 0 0 0

GGC 26.6% 77 290 0 0 0

Lan 17.7% 17 96 0 0 0

WoS 24.1% 124 515 0 0 0

No Board within the WoS met the 35% target. Performance ranged from 17.7% in NHS Lanarkshire to 26.6% in NHS Greater Glasgow and Clyde. The overall performance for the WoS was 24.1%.

0

10

20

30

40

50

60

70

80

90

100

AA FV GGC LAN WoS

Pe

rfo

rman

ce (

%)

NHS Board

Oesophageal2014 2015 2016 2017 QPI Target


Boards have reviewed cases not meeting the target and provided feedback. Boards have commented that this patient group tends to present with advanced/late disease and with multiple comorbidities. This makes curative treatment a very difficult target within this group of patients. NHS Greater Glasgow and Clyde and NHS Lanarkshire both stated that earlier identification of patients is required through the use of awareness campaigns and Barrett’s screening.

Figure 27: The proportion of patients with gastric cancer who underwent curative treatment.




AA 3.8% 1 26 0 0 0

FV 7.1% 1 14 0 0 0

GGC 14.0% 14 100 0 0 0

Lan 25.0% 11 44 0 0 0

WoS 14.7% 27 184 0 0 0

No Board within the WoS met the 35% target. Performance across the region ranged from 3.8% in NHS Ayrshire and Arran to 25.0% in NHS Lanarkshire. The overall performance for the WoS was 14.7%.

Boards have reviewed cases not meeting the target and cited the fact that patients tend to present with advanced/late disease and with multiple comorbidities. Continued efforts are required to identify patients sooner to be able to provide curative treatment.

0

10

20

30

40

50

60

70

80

90

100

AA FV GGC LAN WoS

Pe

rfo

rman

ce (

%)

NHS Board

Gastric2014 2015 2016 2017 QPI Target


QPI 12: 30-day mortality following oncological treatment Treatment related mortality is a marker of the quality and safety of the whole service provided by the Multi Disciplinary Team (MDT). Treatment should only be undertaken in individuals that may benefit from treatment. This QPI is intended to ensure treatment is given appropriately1.

QPI 12 (i): 30/90-day mortality following curative oncological treatment for oesophageal or gastric cancer:

a) Chemoradiotherapy b) Perioperative chemotherapy

(ii) 30-day mortality following palliative oncological treatment for oesophageal or gastric cancer:

c) Chemotherapy

Numerator (i): Number of patients with oesophageal or gastric cancer who receive curative oncological treatment who die within 30 days of treatment.

(ii) Number of patients with oesophageal or gastric cancer who receive palliative oncological treatment who die within 30 days of treatment.

Denominator (i): All patients with oesophageal or gastric cancer who receive curative oncological treatment.

(ii) All patients with oesophageal or gastric cancer who receive palliative oncological treatment.

Exclusions (i)+(ii): No exclusions.

Target (i): < 5% - 30 Day <7.5% - 90 Day

(ii) <5%

30 Day Mortality (Target <5%)

Table 2: Proportion of patients who died within 30 days of treatment.

Oesophageal WoS 2017

a) Chemoradiotherapy 1/39 2.6%

b) Peri-operative chemotherapy 1/65 1.5%

c) Chemotherapy 6/119 5.0%

Gastric

a) Chemoradiotherapy N/A NA


c) Chemotherapy 2/33 6.1%

One of the thirty nine patients with oesophageal cancer who underwent chemoradiotherapy died within 30 days of treatment. There were no patients with gastric cancer treated with chemoradiotherapy. One of the sixty five patients with oesophageal cancer who underwent peri-operative chemotherapy died within 30 days of treatment. Zero out of the twenty one patients with gastric cancer who underwent peri-operative chemotherapy died within 30 days of treatment. Six of the one hundred and nineteen patients with oesophageal cancer who received palliative chemotherapy died within 30 days of treatment. Two of the thirty three patients with gastric cancer who received palliative chemotherapy died within 30 days of treatment. The performances for both oesophageal and gastric 30 day mortality following palliative chemotherapy are slightly over the <5% target.


90 Day Mortality (Target <7.5)

Table 3: Proportion of patients who died within 90 days of treatment.

Oesophageal WoS 2017

a) Chemoradiotherapy 2/36 5.6%


Gastric

a) Chemoradiotherapy N/A NA


Two of the thirty six patients with oesophageal cancer who underwent chemoradiotherapy died within 90 days of treatment. There were no patients with gastric cancer treated with chemoradiotherapy. Two of the fifty eight patients with oesophageal cancer who underwent peri-operative chemotherapy died within 90 days of treatment. Zero out of the twenty patients with gastric cancer who underwent peri-operative chemotherapy died within 90 days of treatment. The <7.5% target was met for all treatment modalities. Boards have provided feedback on all cases of mortality. Feedback indicates that all patients were managed in a clinically appropriate manner and in the majority of cases death was related to progressive disease rather than treatment related toxicity.


QPI 13: HER2 Status

HER2 is a negative prognostic factor affecting recurrence rates. Availability of HER2 status is important to inform treatment decision making. Delay in the availability of HER2 status result may lead to a delay in appropriate therapy and complicate the communication of a clear plan to the patient1.

QPI 13: HER2 status should be available to inform treatment decision making in patients with advanced gastric and gastro-oesophageal junction adenocarcinoma.

Description: Proportion of patients with metastatic gastric or gastro-oesophageal junction adenocarcinoma undergoing first line palliative chemotherapy as their initial treatment for whom the HER2 status is reported prior to commencing treatment.

Numerator: Number of patients with metastatic gastric or gastro-oesophageal junction adenocarcinoma undergoing first line palliative chemotherapy as their initial treatment for whom the HER2 status is reported prior to commencing treatment.

Denominator: All patients with metastatic gastric or gastro-oesophageal junction adenocarcinoma undergoing first line palliative chemotherapy as their initial treatment.

Exclusions: No exclusions

Target: 90%

Figure 28: The proportion of patients with gastric cancer who had HER2 status reported prior to starting treatment.




AA - - - 0 0 0

FV - - - 0 0 0

GGC 90.5% 19 21 0 0 15

Lan 71.4% 5 7 0 0 3


NHS Greater Glasgow and Clyde met the 90% target with a performance of 90.5%. NHS Lanarkshire was short of the target with 71.4% however small numbers are noted. The performances for NHS Ayrshire and Arran and NHS Forth Valley are not shown due to small numbers. The overall performance for the WoS was short of the target at 88.2%.

0

10

20

30

40

50

60

70

80

90

100

AA FV GGC Lan WoS

Pe

rfo

rman

ce (

%)

NHS Board

Gastric

2017 QPI Target

- -


NHS Lanarkshire has reviewed cases not meeting the target and provided feedback. In both instances, HER2 status was reported after palliative treatment had commenced. NHS Lanarkshire will ensure expedited HER2 status requests for this group of patients at time of MDT discussion.


QPI 14: Clinical Trials Access Clinical trials are necessary to demonstrate the efficacy of new therapies and other interventions. Evidence suggests improved patient outcomes when hospitals are actively recruiting patients into clinical trials. Clinicians are therefore encouraged to enter patients into well designed trials and to collect long term follow up data7. The clinical trials QPI is measured utilising Scottish Cancer Research Network (SCRN) data and ISD incidence data, as is the methodology currently utilised by the Chief Scientist Office (CSO) and the National Cancer Research Institute (NCRI). The principal benefit of this approach is that this data is already collected utilising a robust mechanism7.

QPI 14: All patients should be considered for participation in available clinical trials/research studies, wherever eligible.

Description: Proportion of patients diagnosed with Upper GI cancer who are consented for a clinical trial/research study.

Numerator: Number of patients diagnosed with Upper GI cancer consented for a clinical trial/research study.

Denominator: All patients diagnosed with Upper GI cancer.

Exclusions: No exclusions

Target: 15%

Following formal review the Clinical Trials Access QPI was updated to measure the number of patients consented for participation in a clinical trial rather than only those who are enrolled. There are a number of patients who undergo screening but do not proceed to enrolment for various reasons, e.g. they do not have the mutation required for entry on to the trial.

The denominator for this QPI is identified by using a 5 year average of Scottish Cancer Registry data. Table 4: Proportion of patients consented and recruited to clinical trials for upper GI cancer by NHS Board of residence.

Upper GI

Consented (QPI target 15%)

N D %

AA 6 106 5.7%

FV 5 80 6.3%

GGC 21 375 5.6%

Lan 3 152 2.0%

Not Recorded 4 - -

WoS Total* 39 714 5.5% * 3 additional patients residing out with the WoS were consented for trials within the WoSCAN region

No Boards within the WoS met the 15% target for patients who are consented for inclusion in a clinical trial or research study. Results ranged from 2.0% in NHS Lanarkshire to 6.3% in NHS Forth Valley. Thirty nine patients out of seven hundred and fourteen were consented in the WoS, giving a performance of 5.5%. Twenty nine of the thirty nine went on to be recruited into trials. This gives a recruitment rate of 4.1% for the WoS (29/714).


Table 5: List of clinical trials carried out at Beatson West of Scotland Cancer Centre (BWoSCC) in 2017 and the number of patients with Upper GI cancer consented for each clinical trial.

Project Title Consented

2017

An analysis of Relative Telomere Length (RTL) during chemotherapy in patients with advanced gastro-oesophageal adenocarcinoma

8

ST03 SUB STUDY -

BALLAD -

CANC - 4472 (KEYNOTE - 062) -

CANC 5491 -

SCOPE 2 -

CANC - 4443 - Nivolumab in Viral-positive Solid Tumours 10

D081KC00001 (MEDIOLA) Advanced Solid Tumours 6

NUC--3373 in Advanced Solid Tumours (NuTide: 301) -

LY3143921:A Cancer Research UK Phase I trial of LY3143921 hydrate (a CDC7 inhibitor) given orally once daily in adult patients with advanced solid tumours.

-

AN EXPLORATORY BIOMARKER ANALYSIS IN BLOOD AND URINE OF PATIENTS WITH MALIGNANT DISEASE.

-

Total 42

- Denominator is less than 5


5. Conclusions

Cancer audit has underpinned much of the regional development and service improvement work of the MCN and the regular reporting of activity and performance have been fundamental in assuring the quality of care delivered across the region. Following the development of QPIs, this has now become an established national programme to drive continuous improvement and ensure equity of care for patients across Scotland. West of Scotland Boards’ continued commitment to the improvement of the quality and completeness of audit data has provided accurate data for the reporting of performance against the Upper GI Cancer QPIs from which yearly comparisons in service provision across WoS Boards can be made. Analysis of the QPIs indicates that targets have been met by all Boards for post surgical mortality and longitudinal resection margins. Further improvement is required for nutritional assessment, recording of treatment intent at MDT and curative treatment rates. Where QPI targets were not met NHS Boards have provided detailed commentary. In the main these indicate valid clinical reasons, or that in some cases patient choice or co-morbidities have influenced patient management. Additionally, NHS Boards have indicated where positive action has already been taken at a local level to address any issues highlighted through the QPI data analysis. It is anticipated that these positive changes will result in improved performance going forward. Boards are asked to develop local Action/Improvement Plans in response to the findings presented in the report. A summary of actions has been included within the Action Plan templates in the Appendix. Actions required: QPI 4: Staging and Treatment Intent


QPI 8: Lymph Node Yield



QPI 9: Length of Hospital Stay Following Surgery


Completed Action Plans should be returned to WoSCAN within two months of publication of this report.

The MCN Advisory Board will actively monitor progress against changes implemented by NHS Boards, and any service issue the Advisory Board considers not to have been adequately


addressed, will be escalated to the appropriate NHS Board Lead Cancer Clinician and the Regional Lead Cancer Clinician. In addition, progress will be reported annually to the Regional Cancer Advisory Group (RCAG) by NHS Board Lead Cancer Clinicians and MCN Clinical Leads, and nationally on a three-yearly basis to Healthcare Improvement Scotland as part of the governance processes set out in CEL 06 (2012).


6. Acknowledgements

This report has been prepared using clinical audit data provided by each of the NHS Boards in the WoSCAN area. We would like to thank colleagues in the clinical effectiveness departments throughout the West of Scotland for gathering, submitting and verifying these data. We would also like to thank the clinicians, nurses and others involved in the management of upper GI cancer in the West of Scotland for their contribution.


7. Abbreviations

AA NHS Ayrshire & Arran

ACaDMe Acute Cancer Deaths and Mental Health (information system)

CNS Clinical Nurse Specialist

e-CASE Electronic Cancer Audit Support Environment

EUS Endoscopic Ultrasound

FV NHS Forth Valley

GGC NHS Greater Glasgow and Clyde

GI Gastro-intestinal

ISD Information Services Division (NHS National Services Scotland)

Lan NHS Lanarkshire

MCN Managed Clinical Network

MDT Multidisciplinary Team

SACT Systemic anti-cancer therapy

QIS Quality Improvement Scotland

QPIs Quality Performance Indicators

RCAG Regional Cancer Advisory Group

TNM Tumour, Nodes, Metastases (staging system)

WoS West of Scotland

WoSCAN West of Scotland Cancer Network


8. References

1. Upper GI Cancer. Clinical Quality Performance Indicators. December 2012. Available

at: http://www.healthcareimprovementscotland.org/our_work/cancer_care_improvement/programme_resources/cancer_qpis.aspx [Accessed on: 20th September 2018]

2. ISD, NHS National Services Scotland. Summary Statistics for Oesophageal Cancer. Available at: http://www.isdscotland.org/Health-Topics/Cancer/Cancer-Statistics/Oesophagal/ [Accessed on: 24th September 2018]

3. ISD, NHS National Services Scotland. Summary Statistics for Stomach Cancer.

Available at: http://www.isdscotland.org/Health-Topics/Cancer/Cancer-Statistics/Stomach/ [Accessed on: 24th September 2018]

4. Information Services Division. Cancer in Scotland. June 2004 [updated April 2018]

Available at: http://www.isdscotland.org/Health-Topics/Cancer/Publications/2018-04-24/Cancer_in_Scotland_summary_m.pdf [Accessed on: 24th September 2018]

5. ISD, NHS National Services Scotland. Trends in Cancer Survival in Scotland, 1983-2007. August 2010. Available at: http://www.isdscotland.org/Health-Topics/Cancer/Cancer-Statistics/Survival_summary_8307.pdf?1 [Accessed on: 24th September 2018]

6. UICC (Union for International Cancer Control). TNM Classification of Malignant

Tumours. 7th Edition. Wiley-Blackwell; 2009.

7. Clinical Trials Quality Performance Indicator. July 2014 (updated October 2017). Available at: http://www.healthcareimprovementscotland.org/our_work/cancer_care_improvement/programme_resources/cancer_qpis.aspx [Accessed on: 20th September 2018]

http://www.healthcareimprovementscotland.org/our_work/cancer_care_improvement/programme_resources/cancer_qpis.aspx


http://www.isdscotland.org/Health-Topics/Cancer/Cancer-Statistics/Oesophagal/

http://www.isdscotland.org/Health-Topics/Cancer/Cancer-Statistics/Oesophagal/

http://www.isdscotland.org/Health-Topics/Cancer/Cancer-Statistics/Stomach/

http://www.isdscotland.org/Health-Topics/Cancer/Cancer-Statistics/Stomach/

http://www.isdscotland.org/Health-Topics/Cancer/Publications/2018-04-24/Cancer_in_Scotland_summary_m.pdf

http://www.isdscotland.org/Health-Topics/Cancer/Publications/2018-04-24/Cancer_in_Scotland_summary_m.pdf

http://www.isdscotland.org/Health-Topics/Cancer/Cancer-Statistics/Survival_summary_8307.pdf?1

http://www.isdscotland.org/Health-Topics/Cancer/Cancer-Statistics/Survival_summary_8307.pdf?1




Copyright

The content of this report is © copyright WoSCAN unless otherwise stated.

Organisations may copy, quote, publish and broadcast material from this report without payment

and without approval provided they observe the conditions below. Other users may copy or

download material for private research and study without payment and without approval provided

they observe the conditions below.

The conditions of the waiver of copyright are that users observe the following conditions:

Quote the source as the West of Scotland Cancer Network (WoSCAN).

Do not use the material in a misleading context or in a derogatory manner.

Where possible, send us the URL.

The following material may not be copied and is excluded from the waiver:

The West of Scotland Cancer Network logo.

Any photographs.

Any other use of copyright material belonging to the West of Scotland Cancer Network requires

the formal permission of the Network.


Appendix 1: NHS Board Action Plans

A summary of actions for each NHS Board has been included within the Action Plan templates in Appendix 1. Completed Action Plans should be returned to WoSCAN within two months of publication of this report.

Action / Improvement Plan

No Action Required NHS Board Action Taken Timescales Lead Progress/Action Status Status (see key)

Start End

Ensure actions mirror those detailed in Audit Report.

Detail specific actions that will be taken by the NHS Board.

Insert date

Insert date

Insert name of responsible lead for each action.

Provide detail of action in progress, change in practices, problems encountered or reasons why no action taken.

Insert No. from key above

8 Provide detailed feedback for patients with oesophageal and gastric cancer who did not meet the target, and to identify barriers/strategies to improve performance.

NHS Board: NHS Greater Glasgow and Clyde KEY (Status)

Action Plan Lead: 1 Action fully implemented

Date: 2 Action agreed but not yet implemented

3 No action taken (please state reason)


Action / Improvement Plan

No Action Required NHS Board Action Taken Timescales Lead Progress/Action Status Status (see key)

Start End

Ensure actions mirror those detailed in Audit Report.

Detail specific actions that will be taken by the NHS Board.

Insert date

Insert date

Insert name of responsible lead for each action.

Provide detail of action in progress, change in practices, problems encountered or reasons why no action taken.

Insert No. from key above

4 Ensure that treatment intent is recorded at MDT for all patients where appropriate.

8 Continue work to improve communication between surgical sites and central pathology department in order to maximise opportunities for fresh tissue analysis.

9 Investigate sources of error in SMR01 data and provide results of local review of patients with oesophageal and gastric cancer to the MCN.

NHS Board: NHS Lanarkshire KEY (Status)

Action Plan Lead: 1 Action fully implemented

Date: 2 Action agreed but not yet implemented

3 No action taken (please state reason)

Date post:	05-Sep-2020
Category:	Documents
Upload:	others
View:	1 times
Download:	0 times

West of Scotland Cancer Network Upper Gastro-intestinal Cancer … · 2019. 4. 15. · West of...

Documents