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National Prostate Cancer Audit
Julie Nossiter, Project ManagerClinical Effectiveness Unit – Royal College of Surgeons of England
Prospective audit development
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Introduction
• Prospective audit designed to address two key concerns:
• The management of men with low-risk disease– Are patients being over-treated that could be appropriately managed
by active surveillance?
• Use of multimodality therapy* for men with high-risk localised or locally advanced prostate cancer– Are these patients being under-treated?
*hormones and external beam radiotherapy; surgery followed by adjuvant or early salvage radiotherapy
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Prospective audit
• Data collection started on the 1st April 2014 in England:– Characteristics of all newly diagnosed men, how their cancer was
detected & the referral pathway– Crucial steps in the diagnostic & staging process– The planning of initial treatment & initial treatments given
• NPCA will also systematically measure the functional impact of radical therapies on patients’ lives (PROMs/PREMs)– 18 months’ after diagnosis
• Provide key information on current practice and outcomes: – Early complications, longer term survival & quality of life– Compared with NICE Quality Standards– Generate QPIs
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Design of the NPCA MDS: key principles
• All men with newly diagnosed prostate cancer
• Data on their diagnosis, staging and initial treatment should be collected during the initial phase of management and available at meetings of the MDT – ‘All patients with a new diagnosis of PC should be discussed at a MDT
meeting’ NICE 2002
• The burden of data collection on staff and patients should be kept to a minimum
• The audit data items should be available soon after they are generated in clinical practice
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A new generation of national cancer audit
• Key characteristics of NPCA prospective audit:– based on Cancer Outcomes and Services dataset (COSD) items as
much as possible– National Cancer Registration Service (NCRS) is data collection partner
• Developed ‘minimum dataset (MDS)’ – Project team in consultation with stakeholders– Utilised COSD items, BAUS & created NEW items where appropriate– 50 data items in total (now 49 – 2xCOSD items removed)– only 20 new data items (now 21)
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• NPCA contact database developed & updated – Communication with trust teams about the audit
• NPCA Prospective Audit Information Package – Detailed data set specification– Data dictionary & guidance document– Summary handout & FAQ
• MDT system suppliers– 50% of trusts use Somerset, 25% InfoFlex, 25% ‘Other’– Worked with Somerset and Infoflex to implement within systems
• NCRS regional offices– Coordination of CG approval & distribution of NPCA Information
Package (also available @ www.npca.org.uk)– Help-desk function for trusts– Accept test extracts as local IT teams upgrade MDT systems
MDS implementation: England
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• Mechanism for collection & submission of data for the NPCA mirrors COSD
• Frequency of data submission is monthly by designated dates post diagnosis/treatment, e.g:• November 2014 data by 6th January 2015• December 2014 data by 5th February 2015
• NPCA data is subsequently exported from MDT software systems and submitted to local NCRS offices along with routine COSD submission
• It was anticipated that it may take a few months to fully implement appropriate mechanisms for data collection & to align with COSD submission schedule• Possible to plug data gaps at a later submission
• Participation has increased month on month• Update from Regina, NCRS including launch of monthly Quality Reports (data
completeness)
Collection & submission of data: England
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Schematic of NPCA data collation
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• Included in NHS Wales National Clinical Audit and Outcome Review plan– Participation is mandated
• Mechanism for data collection & submission is currently being developed
• NHS Wales Information Service are developing software updates to the national Canisc system– Mapping NPCA dataset
• NPCA has received confirmation that the data collection process in Wales will start in April 2015– NPCA will work with colleagues in Wales during implementation of the
MDS & dissemination of the necessary guidance
Collection & submission of data: Wales
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NPCA Prospective Audit MDS
• MDS 1. all newly diagnosed men with PC during MDT meeting (s) to discuss initial phase of treatment – more detail and data item change in the following slides
• MDS 2. all men with PC who have undergone radical prostatectomy – Paul will explore in more detail and explain data item changes
• MDS 3. all men with PC for whom external beam radiotherapy or brachytherapy +/- androgen deprivation therapy are planned – Ajay will explain rationale behind collection of planned items and
propose mechanism for data collection
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MDS 1: introduction
• 9 routinely collected mandated COSD items: patient identity & demographic details; NHS Trust/MDT/Consultant
• Collect clinical data on the patient, their cancer and their initial treatment plan (summary handout in delegate pack)– 20 clinical items in total : 11 in COSD, 9 new items including 2 in
RCPath
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MDS 1: Case-mix adjustment
• NPCA will take account of differences in mix of patients between providers– Age & ethnicity, socioeconomic status, overall physical condition,
comorbidity and pre-existing urinary symptoms
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MDS 1: Source of referral
• Approx. 25% patients first diagnosed with cancer after an emergency hospital admission– Early detection is an important determinant of treatment outcome
• NPCA will determine variation in the way PC is diagnosed– Geographical variation, relationship with disease stage at
presentation, treatment allocation and ultimately outcomes
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MDS 1: Risk Stratification• NPCA will collect information on a patient’s definitive
diagnosis of PC – Biopsy type, biopsy histology, D’Amico risk stratification
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MDS 1:Multiparametric MRI
• NPCA will determine whether men undergo mpMRI before prostate biopsy as an initial step in the diagnostic pathway
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MDS 1: Patient pathways
• NPCA will determine the patient pathway following diagnosis – type/s of clinical specialist men are seen by and in what setting
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MDS 1 data item change: Planned treatments
• ‘Planned prostate cancer treatment’ was captured during MDT prior to discussion with patient– ‘back mapped’ to COSD item ‘Planned treatments’– ‘all options’ captured = limited utility
• NPCA will collect: Planned Prostate Cancer Treatment agreed with the Patient– Treatment plan agreed with the patient – only one plan (may be a
combination of radiotherapy and hormones)
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Thank You