Northern Oesophago Gastric Cancer Unit MDT data NECN Audit Meeting - PowerPoint PPT Presentation

Northern Oesophago Gastric Cancer Unit MDT data NECN Audit Meeting – November 2015

Methods • Patients discussed at weekly Newcastle Multi-disciplinary Team meeting in period January – December 2014 • Prospective data entry onto database - Dendrite • Intended use: Local, Regional & National audit Research • Data then exported onto Microsoft Excel for analysis

National Audit Programme – Operations from 2011 to 2013. Published 2014 report Operations • Overall 5,396 surgical records were submitted – 95.0% Curative intent – 4.3% Palliative intent and 0.7% Unknown. • Curative Operations – 2,986 Oeosphagectomies – 1,807 Gastrectomies – Increase in proportion of minimally invasive (MI) operations • Oesophagectomies: 41.5% MI or Hybrid • Gastrectomies: 15.9% MI.

National Audit 2011-2013 – curative surgery only – reported, Annual report 2014 No of cases Derby Barking Portsmouth Guildford - Surrey Marsden Barts Norwich Coventry Leeds Southampton Middlesbrough Sheffield Birmingham Oxford Leicester Cambridge Bristol - Univ Plymouth Nottingham Salford Newcastle upon Tyne 0 50 100 150 200 250 300 350

MDT Discussions 0% 20% 40% 60% 80% 100% Total 647 995 870 excl Carlisle 559 excl Carlisle New Rediscussions n=1642 incl Carlisle

New discussions 0% 20% 40% 60% 80% 100% 443 44 88 72 Total (not incl in above fig - 85 Carlisle pts OG Neoplasm & 3 other = 88) OG Neoplasm Benign Carlisle Other Other incl. – GISTs, HGD, LGD & referred onto another MDT N = 647 Ca = 528

New OG neoplasm 0% 20% 40% 60% 80% 100% 313 64 66 Total New Staging In-Patients Restage N = 443

Number of MDT Discussions 200 172 135 150 114 85 100 50 27 15 11 0 No. of Discussions 1 2 3 4 5 6 >6 N=559 – New Discussions Excl. 88 Carlisle pts

Age Positive cancers only discussed at MDT Jan-Dec 2014 Age range Male Female 0 - 30 0 1 31 - 40 2 1 41 - 50 21 7 51 - 60 48 31 61 - 70 137 45 71 - 80 133 71 81 - 90 69 50 91+ 15 15 221patients TOTAL 425 patients (plus 1 unknown age = total 222)

Carlisle Discussions 2014 Carlisle Patients (Total 88) Discussed in MDM 35 32 30 24 25 No. of Patients 20 15 12 9 10 7 4 5 0 1 2 3 4 5 >5 No. of Times Each Patient Discussed in MDT

Intention to treat by site – 2014 Total Sunderland South Tyneside Gateshead NUTH Northumberland Durham 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Curative Palliative No action No action – incl. Benign, Best supportive care & referral onto other MDT’s

Oesophageal Cancer: (2014) Histological subtype Histology 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% ACA SCC Small Cell HGD Other Other incl. – Carcinoma, N = 316 cancer seen on OGJ no path, adenosquam

Oesophageal Cancer: Treatment intent by histological subtype SCC ACA 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Curative Palliative

Oesophageal cancer: Curative treatment intent 0 10 20 30 40 50 60 70 80 ACA 43 21 5 4 SCC 7 2 4 9 9 Other 2 NA+Sx Sx Alone RT CRT R & Sx C RT Sx

Actual Resections - Pos Cancers only 0 20 40 60 80 100 120 140 160 180 2008 53 81 2009 69 68 2010 76 73 2011 80 72 2012 83 85 2013 95 58 2014 76 55 Oesophagectomy Gastrectomy

Procedures 2014 Completed Incompl. 30 day 90 day Comps 3+ Accordion Oesophagectomy 77 1 0 1 20 (incl. 1 benign) Total Gastrectomy 22 1 1 1 1 (incl 1 benign) Subtotal 47 1 0 0 2 Gastrectomy (incl. 13 benign) Lesser resection 13 0 0 0 2 (incl. pall proc.) Total 159 3 1 2 25 1.3% 15.7% EMR 61 N/A 0 0 0

Morbidity/Complications note: 30 day Mort all complications incl. 0% 20% 40% 60% 80% 100% 2009 65 33 2 2010 58 42 2 n=137 - 2009 n=149 - 2010 2011 55 45 0 n=162 - 2011 n=168 - 2012 2012 55 44.5 0.5 n=167 – 2013 N=160 - 2014 2013 49 50.5 0.5 2014 58 41 1 No Complications All Complications Mortality

Oesophageal Cancer: Treatment change Intended Treatment Treatment Change n Neoadjuvant + Surgery Unfit for surgery 3 Neoadjuvant + Surgery Progression of disease, no surgery 9 Neoadjuvant + Surgery RIP patient died no surgery, no neo-adj – 1 2 Neoadjuvant + Surgery Patient catheterised (not suitable for chemo). Surgery 1 only Surgery Surgery offered – patient declined 2 Neoadjuvant + Surgery Shortened chemotherapy due to toxicity 10 Neoadjuvant + Surgery No neoadjuvant given 1 - GFR too Low, progressive disease, no surgery Chemoradiotherapy Radio only 1

Trials – New Trial - ICORG (Ireland Cooperative Oncology Research Group) – R&D approval awaited

UGI Two Week Waits 2014 250 200 150 100 50 2ww 31 day treats 0 62 day treats 62 day breaches 62 day breaches: 46 (2.36%)

Refs- 2 Week Waits – Comparison by Year 2WW 2000 2008 1150 2009 1325 1800 2010 1488 2011 1489 1600 2012 1720 2013 1642 2014 1943 1400 1200 1000 800 600 400 200 0 2008 2009 2010 2011 2012 2013 2014

Breaches – Comparison 50 46 45.5 45 40 35 30.5 30 23 25 20 16 14.5 15 12 10 5 0 2008 2009 2010 2011 2012 2013 2014

Acknowledgements Helen Jaretzke NOGCU Data Manager Angie Tate NOGCU Data Clerk Gillian Reay Nursing Assistant Paula Brooks MDT Coordinator Jonathan Stoddart NCCC Research Coordinator Leigh-Anne Phillips Cancer Services, Cancer Information Manager