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

Northern Oesophago Gastric Cancer Unit MDT data NECN Audit Meeting – November 2014

Methods • Patients discussed at weekly Newcastle Multi-disciplinary Team meeting in period January – December 2013 • Excludes patients discussed by video-link to Sunderland • Prospective data entry onto database - Dendrite • Intended use: Local, Regional & National audit Research • Data then exported onto Microsoft Excel for analysis

National Audit Programme • Patients in England & Wales with epithelial malignancy of oesophagus, stomach and OGJ. • Patients with HGD included from 2012. • NOGCA figures used as basis for data submitted for public consumption by HQIP on individual surgeon’s outcomes since 2013. • A two year data collection is to be published by HQIP in November 2014.

National Audit 2013 – Resections by Centre No of cases Derby Barking Portsmouth Guildford Marsden Barts Norwich Coventry Leeds Southampton Middlesbrough Sheffield Birmingham Oxford Leicester Cambridge Bristol Plymouth Nottingham Salford Newcastle upon Tyne 0 50 100 150

MDT Discussions: N = 1482 0% 20% 40% 60% 80% 100% Total 656 826 (67 Carlisle) (104 Carlisle) New Rediscussions

New discussions: N = 656 0% 20% 40% 60% 80% 100% 443 46 104 63 Total OG Neoplasm Benign Carlisle Other Other incl. – GISTs, HGD, LGD, Surveillance pts, & referred onto another MDT

New OG neoplasm: N = 443 0% 20% 40% 60% 80% 100% 267 112 64 Total New Staging In-Patients Restage

No of MDT re-discussions: N = 552 241 112 94 61 22 12 10 No. of Discussions 1 2 3 4 5 6 >6 Median discussion: 2

Age: N = 534 180 160 140 120 100 Female 80 Male 60 40 20 0 to 30 31-40 41-50 51-60 61-70 71-80 81-90 91 +

Carlisle Discussions 2013 Carlisle Patients (Total 104) Discussed in MDM 50 43 45 40 35 No. of Patients 30 23 25 20 20 15 10 10 5 3 5 0 1 2 3 4 5 >5 No. of Times Each Patient Discussed in MDT

New referrals to MDT by site: Cancers only Unclass'd Others Gateshead 2007 2008 S. Tyneside 2009 2010 2011 Durham 2012 2013 Sunderland Northumb'd Newcastle 0 20 40 60 80 100 120 140 160 180 n=450 vs. 324 vs. 408 vs 467 vs 437 vs 463 vs 443 excl Carlisle pts

Intention to treat by site: 2013 No action – incl. Benign, Best supportive care & Friday MDT’s only referral onto other MDT’s

Oesophageal Ca: Histological subtype 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% ACA SCC Small Cell HGD Other Other incl. – Carcinoma, cancer see on OGJ no path, adenosquam

Oesophageal Ca: Treatment by subtype

Oesophageal cancer: Curative treatment intent Squamous Surgery CT + S CRT + S RT CRT Adeno 0 20 40 60 80 100

Actual Resections: 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 Oesophagectomy Gastrectomy

Procedures 2013 Completed Incompl. 30 day 90 day Comps 3+ Accordion Oesophagectomy 97 4 1 3 29 (incl. 2 benign) 3% Total Gastrectomy 23 4 0 0 5 Subtotal 47 1 0 1 5 Gastrectomy (incl. 2% 12 benign) Lesser resection 16 0 0 3 1 (incl. pall proc.) 19% EMR 49 N/A 0 0 0

Morbidity & Complications n=137 - 2009 n=149 - 2010 n=162 - 2011 n=168 - 2012 n=167 - 2013 30 day or IH

Pathological Stage by subtype 25 Excl. Carcinoid’s & Leioyoma’s excluded, 9 20 open and close excluded. 1 adenosquamous excl. 15 SCC ACA 10 5 0 Tis T0 N1 T1 N0 T1 N1 T1 N2 T2 N0 T2 N1 T2 N2 T3 N0 T3 N1 T3 N2 T3 N3 T4 N0 T4 N1 T4 N2 T4 N3

Oesophageal Cancer: Treatment change Intended Treatment Treatment Change n Neoadjuvant + Surgery Unfit for surgery 2 Neoadjuvant + Surgery Progression of disease, no surgery 7 Neoadjuvant + Surgery RIP (3 cycles) patient died no surgery 1 Neoadjuvant + Surgery Patient declined surgery in UK (pt had neo-adj and went 1 back home) Surgery Not fit for surgery/patient declined 2 Neoadjuvant + Surgery Shortened chemotherapy due to toxicity 9 Neoadjuvant + Surgery No neoadjuvant given - GFR too low, surgery only 2 Radical Radio Patient - suicide 1 Chemoradiotherapy Toxicity - did not complete chemo or radio 1

Recruitment to trials – 2013 100% 90% 80% 70% 10 60% Screened 50% Recruited 40% 30% 7 20% 10% 0%

UGI Two Week Waits 2013 180 160 140 120 100 80 60 40 20 0 2ww Jan Feb March April May June October July August Septemb Novemb Decemb 31 day treats 62 day treats 62 day breaches 62 day breaches: 45.5 (2.7%)

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

Breaches – Comparison 50 45 40 35 30 25 20 15 10 5 0 2008 2009 2010 2011 2012 2013

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