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

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

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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 -

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SLIDE 1

Northern Oesophago Gastric Cancer Unit MDT data

NECN Audit Meeting – November 2015

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SLIDE 2

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
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SLIDE 3

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)

  • perations
  • Oesophagectomies: 41.5% MI or Hybrid
  • Gastrectomies: 15.9% MI.
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SLIDE 4

National Audit 2011-2013 – curative surgery

  • nly – reported, Annual report 2014

50 100 150 200 250 300 350

Newcastle upon Tyne Salford Nottingham Plymouth Bristol - Univ Cambridge Leicester Oxford Birmingham Sheffield Middlesbrough Southampton Leeds Coventry Norwich Barts Marsden Guildford - Surrey Portsmouth Barking Derby

No of cases

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SLIDE 5

MDT Discussions

647 995 0% 20% 40% 60% 80% 100% Total New Rediscussions 870 excl Carlisle

n=1642 incl Carlisle 559 excl Carlisle

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SLIDE 6

New discussions

443 44 88 72 0% 20% 40% 60% 80% 100% Total

OG Neoplasm Benign Carlisle Other

(not incl in above fig - 85 Carlisle pts OG Neoplasm & 3 other = 88)

N = 647 Ca = 528

Other incl. – GISTs, HGD, LGD & referred onto another MDT

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SLIDE 7

New OG neoplasm

313 64 66

0% 20% 40% 60% 80% 100%

Total

New Staging In-Patients Restage

N = 443

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Number of MDT Discussions

50 100 150 200 172 135 114 85 27 15 11

  • No. of Discussions

1 2 3 4 5 6 >6

N=559 – New Discussions

  • Excl. 88 Carlisle pts
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Age

Positive cancers only discussed at MDT Jan-Dec 2014 Age range Male Female 0 - 30 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 TOTAL 425 patients 221patients

(plus 1 unknown age = total 222)

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SLIDE 10

Carlisle Discussions

32 24 12 9 7 4 5 10 15 20 25 30 35 1 2 3 4 5 >5

  • No. of Patients
  • No. of Times Each Patient Discussed in MDT

2014 Carlisle Patients (Total 88) Discussed in MDM

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SLIDE 11

Intention to treat by site – 2014

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Durham Northumberland NUTH Gateshead South Tyneside Sunderland Total

Curative Palliative No action

No action – incl. Benign, Best supportive care & referral onto other MDT’s

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Oesophageal Cancer: (2014) Histological subtype

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Histology

ACA SCC Small Cell HGD Other

Other incl. – Carcinoma, cancer seen on OGJ no path, adenosquam N = 316

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Oesophageal Cancer: Treatment intent by histological subtype

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% ACA SCC

Curative Palliative

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SLIDE 14

Oesophageal cancer: Curative treatment intent

43 7 21 2 5 4 4 9 2 9 10 20 30 40 50 60 70 80 ACA SCC Other

NA+Sx Sx Alone RT CRT R & Sx C RT Sx

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SLIDE 15

Actual Resections - Pos Cancers only

53 69 76 80 83 95 76 81 68 73 72 85 58 55 20 40 60 80 100 120 140 160 180 2008 2009 2010 2011 2012 2013 2014

Oesophagectomy Gastrectomy

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Procedures 2014

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

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Morbidity/Complications

note: 30 day Mort all complications incl.

65 58 55 55 49 58 33 42 45 44.5 50.5 41 2 2 0.5 0.5 1 0% 20% 40% 60% 80% 100% 2009 2010 2011 2012 2013 2014 No Complications All Complications Mortality

n=137 - 2009 n=149 - 2010 n=162 - 2011 n=168 - 2012 n=167 – 2013 N=160 - 2014

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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

  • nly

1 Surgery Surgery offered – patient declined 2 Neoadjuvant + Surgery Shortened chemotherapy due to toxicity 10 Neoadjuvant + Surgery No neoadjuvant given

  • GFR too Low, progressive disease, no surgery

1 Chemoradiotherapy Radio only 1

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SLIDE 19

Trials – New Trial - ICORG (Ireland Cooperative

Oncology Research Group) – R&D approval awaited

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SLIDE 20

UGI Two Week Waits 2014

50 100 150 200 250

2ww 31 day treats 62 day treats 62 day breaches

62 day breaches: 46 (2.36%)

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SLIDE 21

Refs- 2 Week Waits – Comparison by Year

2WW 2008 1150 2009 1325 2010 1488 2011 1489 2012 1720 2013 1642 2014 1943 200 400 600 800 1000 1200 1400 1600 1800 2000

2008 2009 2010 2011 2012 2013 2014

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Breaches – Comparison

5 10 15 20 25 30 35 40 45 50 2008 2009 2010 2011 2012 2013 2014

12 30.5 23 16 14.5 45.5 46

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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