www.npca.org.uk [email protected] national prostate cancer audit julie nossiter, project manager...

www.npca.org.uk [email protected]

National Prostate Cancer Audit

Julie Nossiter, Project ManagerClinical Effectiveness Unit – Royal College of Surgeons of England

Prospective audit development


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


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


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


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)


• 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

http://www.npca.org.uk/


• 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


Schematic of NPCA data collation


• 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


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


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


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


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


MDS 1: Risk Stratification• NPCA will collect information on a patient’s definitive

diagnosis of PC – Biopsy type, biopsy histology, D’Amico risk stratification


MDS 1:Multiparametric MRI

• NPCA will determine whether men undergo mpMRI before prostate biopsy as an initial step in the diagnostic pathway


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


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)


Thank You

www.npca.org.uk [email protected] national prostate cancer audit julie nossiter, project manager...

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