Download Faster cancer treatment indicators

Faster cancer treatment indicators:
Data definitions and reporting for
the indicators
March 2012
Contents
Purpose...................................................................................................................................... 3
Faster cancer treatment indicators ........................................................................................... 4
Rationale ................................................................................................................................ 4
Reporting against the indicators ............................................................................................... 5
Retrospective reporting .......................................................................................................... 5
Data collection responsibility .................................................................................................. 5
Data reporting process ........................................................................................................... 6
Inclusions and exclusions for the indicators.............................................................................. 7
Inclusions ............................................................................................................................... 7
Exclusions .............................................................................................................................. 7
Reportable data items for the indicators .................................................................................. 8
Mandatory data items............................................................................................................. 8
Non-mandatory data items ..................................................................................................... 8
Appendix A: Indicators in practice – use cases....................................................................... 10
Appendix B: Definitions of the mandatory data items ........................................................... 22
Appendix C: Definitions of the non-mandatory data items ................................................... 26
Appendix D: Primary site ICD grouped into tumour streams ................................................. 30
Faster cancer treatment indicators – data definitions and reporting for the indicators
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Purpose
This document introduces the ‘faster cancer treatment’ indicators (the FCT
indicators) which are included as a development measure in the 2012/13 District
Health Board (DHB) Planning Package. DHBs are expected to begin collecting
baseline data on the FCT indicators during 2012/13.
This document identifies the data definitions for the FCT indicators and covers the
necessary definitions for reporting baseline data on the FCT indicators. This sits
alongside the Ministry of Health’s (the Ministry) faster cancer treatment initiatives
supporting quality care, including the development of tumour standards and
pathways.
The definitions for the FCT indicators are based on:
National Cancer Core Data Definitions Interim Standard HISO 10038.3
(2011)
National Health Service (Scotland) New Cancer Waiting Times Targets
Data and Definitions Manual (2010)
National Health Service (Wales) Definitions to support the Cancer Waiting
Times Service and Financial Framework (SaFF) Target (2004).
Faster cancer treatment indicators – data definitions and reporting for the indicators
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Faster cancer treatment indicators
There are three indicators collectively referred to as the FCT indicators. These will
be used to measure the timeliness of cancer treatment. The FCT indicators are:
Indicator one: length of time taken for a patient referred urgently1 with a
high-suspicion2 of cancer to receive their first cancer treatment (or other
management)
Indicator two: length of time taken for a patient referred urgently with a
high-suspicion of cancer to have their first specialist assessment
Indicator three: length of time taken for a patient with a confirmed
diagnosis3 of cancer to receive their first cancer treatment (such as
surgery) or other management (such as palliative care) from decision-totreat4.
Rationale
The FCT indicators focus on the length of time from a high-suspicion of cancer to
when the patient receives their first treatment.
The FCT indicators cover the breadth of the clinical cancer care pathway, including
surgical treatment. Two of the FCT indicators measure from when a patient is
referred with a high-suspicion of cancer (see Figure 1 on page 5).
1
Referred urgently: an urgent referral to a specialist because a person presents with clinical
features indicating high-suspicion of cancer.
2
High-suspicion: means the person presents with clinical features typical of cancer, or has
less typical signs and symptoms but the clinician suspects that there is a high probability of
cancer.
3
The preferred basis of a confirmed cancer diagnosis is pathological, noting that for a small
number of patients cancer diagnosis will be based on diagnostic imaging findings.
4
See Appendix B: Definitions of the mandatory data items, page 22.
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Reporting against the FCT indicators
Reporting against the FCT indicators will be based on four data points. Figure 1
shows the data points that make up the start and stop points of the FCT indicators.
Figure 1: Data points for the three FCT indicators
Indicator two (best practice – 14 days)
Urgent referral
with
high-suspicion of
cancer
First specialist
assessment
Indicator three (best practice – 31 days)
Decision-to-treat
First cancer
treatment
Indicator one (best practice – 62 days)
The FCT indicators are identified as a development measure in the 2012/13 DHB
Planning Package, with data reporting expected from 1 July 2012. DHBs are
expected to begin collecting baseline data on the FCT indicators during 2012/13.
Retrospective reporting
The reporting against the FCT indicators will be retrospective5. This is because the
initial focus is on routinely collecting baseline data on the three FCT indicators across
the tumour types.
During 2012/13 the FCT indicators are reported retrospectively only for the
cohort of patients who at the time of decision-to-treat have a confirmed
diagnosis of cancer. For more information on what this means in practice see
Appendix A: Indicators in practice – use cases.
The nature of the reporting against the FCT indicators will change. The Ministry will
work with the sector to develop tools that support consistent assessment of urgent
referral for high-suspicion of cancer. Following this, the reporting on the length of
time taken will move to real-time monitoring of each patient progressing through the
pathway.
Any changes to the nature of the retrospective reporting will be on an annual basis.
DHBs will be notified at least three months prior to any change taking effect.
Data collection responsibility
The DHB of domicile is responsible for the collection and collation of information on
the data items and submitting this information via the reporting template to the
Ministry, see Data reporting process on page six.
5
Retrospective means that calculating the length of time it takes for each patient against the
FCT indicators happens once the patient has started their first treatment.
Faster cancer treatment indicators – data definitions and reporting for the indicators
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The DHB of domicile is responsible for collecting and reporting information on their
domiciled population even if it is not the DHB of:
receipt of referral
service.
Data reporting process
Data is reported retrospectively, by the DHB of domicile, for all patients who had a
confirmed diagnosis of cancer at decision-to-treat. The required data items must be
reported via the reporting template in the specified format.
The reporting template is accessible on the nationwide service framework library
www.nsfl.health.govt.nz/apps/nsfl.nsf/pagesmh/445.
The reporting template must be submitted to the Ministry via email to
[email protected] by the 20th of the month following the reporting month.
The initial focus is on the collection of baseline information and adjustments may be
made to the reporting template, or reporting frequency if required.
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Inclusions and exclusions for the FCT indicators
The following inclusions and exclusions are detailed for the FCT indicators. For
information on how these inclusions and exclusions work in practice see Appendix A:
Indicators in practice – use cases.
Inclusions
The FCT indicators apply to all patients who:
are eligible for treatment in New Zealand
are either an inpatient or an outpatient
are under the care of adult services
have a confirmed diagnosis6 of cancer7 at decision-to-treat.
Indicator three8 also applies to, patients whose:
cancer has relapsed
pre decision-to-treat pathway is outside the New Zealand public health
system and the patient is then referred to the public health system for
treatment.
Exclusions
Patients are excluded from the FCT indicators if the patient:
has a post decision-to-treat pathway that begins outside the New Zealand
public health system
has cancer diagnosed as an incidental finding at the time of treatment
was referred urgently for a first specialist assessment for high-suspicion of
cancer, which resulted in no confirmed diagnosis of cancer
has low risk non melanoma skin cancer
has non-invasive or non-malignant (benign) tumours
has low-grade, asymptomatic or indolent haematological malignancies
is referred and accepted by child cancer services.
6
The preferred basis of a confirmed diagnosis is pathological, noting that for a small number
of patients diagnosis will be based on diagnostic imaging findings.
7
The cancer diagnosis is either a newly diagnosed primary cancer or a recurrent cancer.
8
The length of time taken for a patient with a confirmed diagnosis of cancer to receive their
first cancer treatment (such as surgery) or other management (such as palliative care) from
decision-to-treat.
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Reportable data items for the FCT indicators
Mandatory data items
The mandatory data items to be reported to the Ministry for the three FCT indicators
are identified in the following table, see also Appendix B: Definitions of the
mandatory data items.
Field
Ethnicity9
DHB of domicile
Date of receipt of referral
DHB of receipt of referral
Date of first specialist assessment
Primary site International Classification of Diseases (ICD) grouped into
tumour stream category10
Date of decision-to-treat
Type of first treatment
Date of first treatment
DHB of service for first treatment
Indicator/s
All
All
1, 2
1, 2
2
All
1, 3
1, 3
1, 3
1, 3
Non-mandatory data items
The following table identifies the data items that the Ministry will expect DHBs to
collect data on in the future. Where possible, DHBs are expected to work towards
collecting these data items following routine collection of the mandatory data items,
see also Appendix C: Definitions of the non-mandatory data items.
Field
National Health Index (NHI)
Age
Episode (of care) identification (ID)
Source of referral11
Urgency of referral
Date patient informed of diagnosis
Date of most valid diagnosis
Date of multidisciplinary meeting (MDM)
Indicator/s
All
All
All
1, 2
1, 2
1, 2
1, 3
1, 3
9
Ethnicity data should be recorded as per standard ethnicity data protocols. This information
is accessible from http://www.health.govt.nz/publication/ethnicity-data-protocols-health-anddisability-sector.
10
See Appendix D: Primary site ICD grouped into tumour streams.
11
Includes acute and elective sources of referral.
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Clock start and stop times for the FCT indicators
The table below identifies when the clock starts and stops for the FCT indicators.
FCT Indicators
Indicator one
Urgent referral with
high-suspicion of cancer
to first cancer treatment.
Indicator two
Length of time taken for
a patient referred
urgently with a highsuspicion of cancer to
have their first specialist
assessment.
Indicator three
Length of time taken for
a patient with a
confirmed diagnosis of
cancer to receive their
first cancer treatment
(such as surgery) or
other management
(such as palliative care)
from decision-to-treat.
12
Clock start
Clock stop
The date of receipt of referral
for the first specialist
assessment led to the patient
being diagnosed with cancer.
The date that the patient had
their first treatment (or other
management).12
The date of receipt of referral
for the first specialist
assessment led to the patient
being diagnosed with cancer.
The date that the patient had the
first specialist assessment that
led to the patient being
diagnosed with cancer.
The date that decision-to-treat
was initiated.
The date that the patient had
their first treatment (or other
management).
First treatment (or other management) is defined in Appendix B.
Faster cancer treatment indicators – data definitions and reporting for the indicators
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Appendix A: FCT indicators in practice – use cases
The following use cases provide examples of how the FCT indicators work in
practice. All the use case diagrams show patients who have been referred from
primary care. Patients who have been referred from an emergency department or
other secondary service for a first specialist assessment with high- suspicion of
cancer are also included in the FCT indicators.
Use case one – surgery is the first treatment
The following use case is an example of a patient who has surgery as first treatment.
The use case demonstrates how surgery is captured in the FCT indicators.
A patient is referred urgently with suspected cancer. The patient is seen by a
surgeon at a first specialist assessment. Ideally the patient’s clinical details are
reviewed at an appropriate multidisciplinary meeting (MDM) for a management
recommendation. The management recommendation is that the patient be offered
surgery as first treatment. The clinician sees the patient in a follow-up assessment,
and decides with the patient that the first treatment is surgery.
The patient will be reported on in the FCT indicators.
The FCT indicator data points are indicated by the
.
Use case one – surgery is first treatment
Diagnostics
Primary care
excluded
included
Presents to general
practitioner with
symptoms *
Patient has a
confirmed
diagnosis of
cancer
Diagnostics
indicate suspected
cancer
Further
diagnostics and
staging
First specialist
assessment
Referral
Discussed at
multidisciplinary
First specialist
surgical
assessment
Receipt of
referral
Data
point
Subsequent
surgical
appointment
meeting *
Data
point
Decision-to-treat
confirmed with booking
request for surgery
Data
point
31 days
Treatment
Decision-totreat
14 days
62 days
Surgical excision of
cancer
Data
point
* This example has a patient who presents to their general practitioner. Patients may also present to emergency departments or other specialities.
* This example notes that ideally the patient is reviewed at an appropriate multidisciplinary meeting.
Use case two – radiation treatment is the first treatment
The following use case is an example of a patient with rectal cancer who has
radiation treatment with concurrent chemotherapy as their first treatment. The use
case demonstrates how radiation treatment is captured in both the FCT indicators
and links to the Shorter waits for cancer treatment health target.
Ideally the patient’s clinical details are reviewed at an appropriate MDM for a
management recommendation. The management recommendation is pre-operative
radiotherapy with concurrent chemotherapy, followed by surgery.
The data on radiation treatment and chemotherapy (decision-to-treat and treatment
commencing) for the patient will be reported twice. The patient will be included in the
three FCT indicators and in the Shorter waits for cancer treatment health target.
The expected maximum timeframe from decision-to-treat to first treatment for
patients who have radiation treatment or chemotherapy13 as their first treatment is 4
weeks (28 days) not 31 days. This is because the Shorter waits for cancer treatment
health target sets a maximum timeframe of four weeks from decision-to-treat to
starting radiation treatment or chemotherapy.
The FCT indicator data points are indicated by the
. The Shorter waits for cancer
treatment health target data points are indicated by the
. The links with the draft
colonoscopy wait time indicator are identified by the
.
13
The Shorter waits for cancer treatment health target includes outpatient chemotherapy from
1 July 2012.
Use case two – radiation treatment is first treatment
Diagnostics
Primary care
excluded
included
Presents to general
practitioner with
symptoms *
Diagnostics
indicate suspected
cancer
Data
point
Accepted for
colonoscopy
Patient has a
confirmed
diagnosis of
cancer
Data
point
Further
diagnostics and
staging
Colonoscopy
First specialist
assessment
Referral
Discussed at
multidisciplinary
First specialist
surgical
assessment
Receipt of
referral
Data
point
meeting *
Subsequent
surgical
appointment
First specialist
radiation oncology
assessment
First specialist
medical oncology
assessment
Data
point
Data
point
28 days *
Treatment
Decision-totreat
14 days
62 days
Data
point
Decision-to-treat
confirmed with booking
request for radiation
treatment
Radiation treatment
commenced with
concurrent
chemotherapy
Data
point
Data
point
* This example has a patient who presents to their general practitioner. Patients may also present to emergency departments or other specialities.
* This example notes that ideally the patient is reviewed at an appropriate multidisciplinary meeting.
* Where first treatment is radiation treatment or chemotherapy the timeframe from decision-to-treat to first treatment is 4 weeks (28 days) not 31 days. This is because the Shorter waits for cancer
treatment health target sets a maximum timeframe of 4 weeks from decision-to-treat to starting radiation treatment and chemotherapy.
Use case three – chemotherapy is the first treatment
The following use case is an example of a patient who has chemotherapy as their
first treatment. The use case demonstrates how chemotherapy is captured in the
FCT indicators and links to the Shorter waits for cancer treatment health target.
A patient is referred urgently with suspected cancer. The patient is seen at a first
specialist assessment. Ideally the patient’s clinical details are reviewed at an
appropriate MDM for a management recommendation. The management
recommendation is chemotherapy as first treatment. The patient will be reported on
in both the FCT indicators and the Shorter waits for cancer treatment health target.
The expected maximum timeframe from decision-to-treat to first treatment for
patients who have radiation treatment or chemotherapy (outpatients only) as their
first treatment is 4 weeks (28 days) not 31 days. This is because the Shorter waits
for cancer treatment health target sets a maximum timeframe of four weeks from
decision-to-treat to starting radiation treatment and chemotherapy.
The FCT indicator data points are indicated by the
and the Shorter waits for
cancer treatment health target data points are indicated by the
.
Use case three – chemotherapy is first treatment
Diagnostics
Primary care
excluded
included
Presents to general
practitioner with
symptoms *
Patient has a
confirmed
diagnosis of
cancer
Diagnostics
indicate suspected
cancer
Further
diagnostics and
staging
First specialist
assessment
Referral
Receipt of
referral
Discussed at
multidisciplinary
First specialist
assessment
Data
point
Subsequent
appointment
meeting *
Data
point
Decision-totreat
14 days
Treatment
28 days *
Decision-to-treat
confirmed with booking
request for
chemotherapy
Data
Data
point
point
Chemotherapy started
Data
point
Data
point
62 days
* This example has a patient who presents to their general practitioner. Patients may also present to emergency departments or other specialities.
* This example notes that ideally the patient is reviewed at an appropriate multidisciplinary meeting.
* Where first treatment is radiation treatment or chemotherapy the timeframe from decision-to-treat to first treatment is 4 weeks (28 days) not 31 days. This is because the Shorter waits for cancer
treatment health target sets a maximum timeframe of 4 weeks from decision-to-treat to starting radiation treatment and chemotherapy.
Use case four – care accessed across multiple DHBs
The following use case is an example of a patient who has their first specialist
assessment at their DHB of domicile, and their treatment at a different DHB.
The patient was referred urgently with suspected cancer. The patient was able to be
seen by a visiting clinician at a first specialist assessment in their local hospital (DHB
of domicile). The clinician had diagnostic information available indicating that the
patient has cancer and was therefore able to diagnose the patient with cancer. The
clinician submitted the booking request for urgent surgical treatment at a different
DHB. The patient had their surgery at a different hospital in a different DHB.
The patient will be reported on in the FCT indicators. It is the responsibility of the
DHB of domicile to report information on the patient as part of the FCT indicators.
The FCT indicator data points are indicated by the
.
Use case four – care accessed across multiple DHBs
included
Presents to general
practitioner with
symptoms *
Patient has a
confirmed
diagnosis of
cancer
Diagnostics
Primary care
excluded
Diagnostics
indicate suspected
cancer
Further
diagnostics and
staging
First specialist
assessment
Referral
Receipt of
referral
Data
point
Patient attends first
specialist surgical
assessment at their own
DHB hospital
Patient attends subsequent
surgical appointment at
another DHB hospital
* Ideally an MDM
discussion
Data
point
Decision-totreat
14 days
Decision-to-treat
confirmed with booking
request for surgery
Treatment
31 days
Data
point
Surgical excision for
cancer
Data
point
62 days
* This example has a patient who presents to their general practitioner. Patients may also present to emergency departments or other specialities.
DHB of
domicile is
responsible
for collecting
information
from the
DHB of
service
* This example notes that ideally the patient is reviewed at an appropriate multidisciplinary meeting.
Faster cancer treatment indicators – data definitions and reporting for the indicators
18
Use case five – first treatment is palliative care
The following use case is an example of a patient whose first treatment is palliative
care. The patient was referred urgently with suspected cancer. The patient was
seen at a first specialist assessment, and the clinician had diagnostic information
available indicating that the patient has cancer. The clinician was able to diagnose
the patient with cancer.
Ideally the patient’s clinical details are reviewed at an appropriate multidisciplinary
meeting for a management recommendation. The management recommendation is
palliative care as first treatment. The clinician and patient discussed the treatment
options, and agreed that palliative care was the best approach. In this use case
example the clinician discharged the patient to their primary health care professional
for palliative care. This is included in the FCT indicators. Pathways for palliative
care are variable and can include referral to hospital palliative care teams or to
community hospice services.
If the patient subsequently has additional symptoms requiring further treatment, for
example the patient’s primary health care professional referred the patient for
palliative radiation treatment, this would be included in the Shorter waits for cancer
treatment health target. Equally the patient may be subsequently referred for surgery
although this is not a measure at the present time (as this would not be the first
treatment).
The FCT indicator data points are indicated by the
.
Use case five – first treatment is palliative care
Diagnostics
Primary care
excluded
included
Presents to general
practitioner with
symptoms *
Patient has a
confirmed
diagnosis of
cancer
Diagnostics
indicate suspected
cancer
Further
diagnostics and
staging
First specialist
assessment
Referral
Receipt of
referral
Discussed at
multidisciplinary
First specialist assessment
Subsequent appointment
meeting *
Data
point
Data
point
Decision-to-treat confirmed with
patient discharged back to
primary care
Data
point
31 days
Treatment
Decision-totreat
14 days
62 days
Data
point
for palliative care *
Date of decision-to-treat is date
of treatment for palliative care
in this example
* This example has a patient who presents to their general practitioner. Patients may also present to emergency departments or other specialities.
* This example notes that ideally the patient is reviewed at an appropriate multidisciplinary meeting.
* This example provides one of the options for palliative care, that is that a patient is discharged to their general practitioner. There are multiple pathways to palliative care treatment including
hospital palliative care assessment and referral to hospice palliative care.
Use case six – non-malignant or low grade tumours
Patients diagnosed with non-malignant or low grade tumours, for example ductal
carcinoma in situ (DCIS) of the breast or chronic leukaemia, are excluded from the
FCT indicators.
Use case seven – referred urgently, not diagnosed with cancer
This example describes a patient who is referred urgently with a high-suspicion of
cancer and subsequently not diagnosed with cancer.
A patient is referred urgently with suspected cancer. The patient is seen by a
clinician at a first specialist assessment. The clinician refers the patient for additional
diagnostic tests. The diagnostic tests do not confirm the suspected cancer.
As the FCT indicators are retrospectively reported on for patients who at decision-totreat have a confirmed diagnosis of cancer, this patient is excluded for all of the FCT
indicators.
Use case eight – cancer diagnosed at surgery
This example describes a patient whose cancer is diagnosed when they have their
surgery. Where diagnosis is confirmed at the time of first treatment, the patient does
not have a cancer diagnosis at the point of decision-to-treat. They are therefore
excluded from the FCT indicators.
The patient and their clinician discussed the treatment options following surgery
including adjuvant radiation treatment or chemotherapy and agreed that radiation
treatment was the best approach. The patient is therefore included in the Shorter
waits for cancer treatment health target.
Use case nine – first treatment private, followed by public adjuvant14 treatment
This example describes a patient who is seen by a clinician at a first specialist
assessment in a private clinic. The patient is diagnosed with cancer and has their
first treatment (surgery) for cancer in a private facility. Following surgery, the patient
is referred for public adjuvant radiation treatment. This scenario could equally be that
the patient is referred for public adjuvant chemotherapy.
As the patient has their first treatment in private they are excluded from the FCT
indicators. However, the patient’s public adjuvant treatment is included in the Shorter
waits for cancer treatment health target.
14
Adjuvant treatment is treatment that is given in addition to the primary, main or initial
treatment.
Appendix B: Definitions of the mandatory data items
Receipt of referral definition
Definition:
The receipt of referral date is the date the initial referral from primary care
including dental is received into secondary care.
Electronic referrals
Best practice is for referrals to be submitted electronically. Where referrals
are submitted electronically the date of receipt of referral is the submission
date on the electronic referral.
Letter or faxed referrals
When referrals are made by letter or fax the date of receipt of referral is the
date with which the referral is stamped as having first being received in
secondary care.
Telephone referrals
When referrals are made by telephone the date of receipt of referral is the
date stamped on the formal referral (following the telephone conversation)
when it has been received in secondary care.
Source
standards:
National Cancer Core Data Definitions Interim Standard HISO 10038.3
October (2011).
Data type:
Date
Representational class:
Full date
Field size:
8
Representational layout:
CCYYMMDD
Obligation:
Mandatory
Data domain:
Valid date
Guide for use:
On occasion, there will be multiple referrals for an individual patient.
Where a patient has been accepted into another care pathway a clinical
decision will need to be made as to whether the newer referral overrides
the current pathway or not. The clinical decision needs to be documented
and will determine the date of receipt of referral.
Electronic referrals must consider the Referrals, Status and Discharge
Referrals (RSD) suite of standards. These provide guidance for electronic
information exchange when all or part of patient care is transferred from
one health care provider to another as based on HL7 V2.4.
Verification
rules:
>= Patient: Date of Birth
<= Patient: Date of Death
Decision-to-treat definition
Definition:
The decision-to-treat is the date when the decision was made for the
patient’s treatment plan or other management plan, following discussion
between the patient and the clinician responsible for treatment.
Source
standards:
National Health Service Scotland New Cancer Waiting Times Targets Data
and Definitions Manual (2010).
Data type:
Date
Representational class:
Full date
Field size:
8
Representational layout:
CCYYMMDD
Obligation:
Mandatory
Data domain:
Valid date
Guide for use:
Where there are two possible dates, the earliest date applies. When a
patient has been discussed in a MDM, it is in the best interests of the
patient that the decision-to-treat discussion with the patient takes place as
soon as possible after the MDM.
Where decision-to-treat is not routinely collected, the date that a booking
request for treatment is made can be used as a surrogate for decision-totreat.
Verification
rules:
N/A
Faster cancer treatment indicators – data definitions and reporting for the indicators
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Type of first treatment definition
Definition:
The type of first treatment is defined as the treatment or other
management that attempts to begin the patient’s first treatment, including
palliative care.
Source
standards:
National Cancer Core Data Definitions Interim Standard HISO 10038.3
October (2011).
National Health Service Scotland New Cancer Waiting Times Targets Data
and Definitions Manual (2010).
Data type:
Numeric
Representational class:
Code
Field size:
2
Representational layout:
NN
Obligation:
Mandatory
Data domain:
Guide for use:
Value
00
01
Meaning
Other, please specify
Surgery: exclude diagnostic procedures such as punch,
incisional, needle or core
02
Radiation therapy
03
Chemotherapy
Targeted therapy: refers to a medication / drug that
04
targets a specific pathway in the growth and development
of a tumour
Non-intervention management: an expectant approach
05
pending change in the patient’s circumstances. It is a
period of active management not unmanaged nontreatment
06
Palliative care: an active decision for palliative care
07
Patient refused treatment
08
Patient died before treatment
99
Not recorded
Patients should be included if first treatment is attempted but not carried
out or completed for clinical reasons. For example ‘open and shut surgery’
would be coded under 01 surgery.
Patient’s diagnostic biopsy should only be included as first treatment when
the whole tumour has been removed and the margins are clear.
Where first treatment is a clinical trial, the date of first treatment is
considered to be enrolment in a clinical trial.
Where first treatment is targeted therapy – hormone therapy, the date of
first treatment is considered to be the date the prescription is written for the
treatment.
Verification
rules:
N/A
Faster cancer treatment indicators – data definitions and reporting for the indicators
24
Delay code definition
Definition:
When the time taken for a patient to track through the patient pathway is
outside the time identified for the indicator the overall time taken and the
main reason for the delay must be reported.
Source
standards:
National Health Service Scotland New Cancer Waiting Times Targets Data
and Definitions Manual (2010).
National Health Service Wales Definitions to support the Cancer Waiting
Times SaFF Target (2004).
Data type:
Numeric
Representational class:
Code
Field size:
2
Representational layout:
NN
Obligation:
Conditional
Data domain:
Value
00
01
02
03
04
05
06
07
08
09
98
99
Meaning
Other, please specify
Capacity constraint resulting from lack of resources
(theatre, equipment or facilities) or process constraint
including administrative errors
Routine staging or further investigation
Clinical consideration (co-morbidities)
Initially not suspicious of cancer
Patient choice to delay
Inadequate information available at FSA, unable to initiate
decision-to-treat discussion (system / process issues)
Unable to initiate decision-to-treat discussion patient
circumstances changed
Patient did not attend scheduled appointment
Patient died before treatment
Not applicable
Not recorded
Guide for use:
The main reason for delay is any capacity or process delay. If no capacity
or process delay occurred, the main reason for delay is the reason that
contributed the longest delay. Or if there are two delays of equal length,
the first delay that occurred.
Verification
rules:
N/A
Faster cancer treatment indicators – data definitions and reporting for the indicators
25
Appendix C: Definitions of the non-mandatory data items
Episode ID definition
Definition:
Unique identifier for this record.
Source
standards:
National Cancer Core Data Definitions Interim Standard HISO
10038.3 October (2011).
Data type:
Numeric
Representational class:
Number
Field size:
11
Representational layout:
N(11)
Obligation:
Mandatory
Data domain:
Number
Guide for use:
System generated primary key for this record.
Verification
rules:
N/A
Faster cancer treatment indicators – data definitions and reporting for the indicators
26
Source of referral definition
Definition:
The source of the referral is defined by the facility / health professional that
made the referral.
Source
standards:
National Health Service Scotland New Cancer Waiting Times Targets Data
and Definitions Manual (2010).
Data type:
Numeric
Representational class:
Code
Field size:
2
Representational layout:
NN
Obligation:
Mandatory
Data domain:
Value
00
01
02
03
04
05
06
07
08
09
N/A
Guide for use:
Verification
rules:
Meaning
Other, please specify
Primary care clinician / practice
Primary dental clinician / practice
Accident and medical / after-hours
Emergency department
Other hospital department
Other hospital
Private specialist / hospital
National screening programme
Unknown
N/A
Faster cancer treatment indicators – data definitions and reporting for the indicators
27
Date of most valid diagnosis definition
Definition:
The date on which the patient was definitively diagnosed with a
particular condition or disease.
Source
standards:
National Cancer Core Data Definitions Interim Standard HISO
10038.3 October (2011).
Data type:
Date
Representational class:
Full date
Field size:
8
Representational layout:
CCYY[MM[DD]]
Obligation:
Conditional
Data domain:
Valid date
Guide for use:
The date of diagnosis is the date of the pathology report, if any, that
first confirmed the diagnosis of cancer. This date may be found
attached to a letter of referral or a patient's medical record from
another institution or hospital. If this date is unavailable, or if no
pathological test was done, then the date may be determined from
one of the sources listed in the following sequence:
1. Date of the consultation at, or admission to, the hospital,
clinic or institution when the cancer was first diagnosed.
Note: do not use the admission date of the current admission
if the patient had a prior diagnosis of this cancer.
2. Date of first diagnosis as stated by a recognised medical
practitioner or dentist. Note: This date may be found
attached to a letter of referral or a patient's medical record
from an institution or hospital.
3. Date the patient states they were first diagnosed with cancer.
Note: This may be the only date available in a few cases (for
example, patient was first diagnosed in a foreign country).
The CCYY component of the date is mandatory. MM is conditional
(use if known). DD is conditional (use if known and MM has been
recorded).
If a patient is admitted for another condition (for example a broken leg
or pregnancy), and a cancer is diagnosed incidentally then the date of
diagnosis is the date the cancer was diagnostically determined, not
the admission date.
Verification
rules:
>= Patient: Date of Birth
<= Patient: Date of Death
Faster cancer treatment indicators – data definitions and reporting for the indicators
28
First MDM meeting date definition
Definition:
Date on which the patient was first discussed at a MDM.
Source
standards:
National Cancer Core Data Definitions Interim Standard HISO
10038.3 October (2011).
Data type:
Date
Representational class:
Full date
Field size:
8
Representational layout:
CCYY[MM[DD]]
Obligation:
Conditional
Data domain:
Valid date
Guide for use:
The CCYY component of the date is mandatory. MM is conditional
(use if known). DD is conditional (use if known and MM has been
recorded).
Verification
rules:
N/A
Faster cancer treatment indicators – data definitions and reporting for the indicators
29
Appendix D: Primary site ICD grouped into tumour streams
The ICD codes (10th Edition) should be recorded to the third digit for all cancers. The
ICD codes can be reported based on the following grouped tumour streams.
ICD codes
to third digit
C00
C01
C02
C03
C04
C05
C06
C07
C08
C09
C10
C11
C12
C13
C14
C30
C31
C32
C73
C77
C15
C16
C22
C23
C24
C25
C17
C18
C19
C20
C21
C26
C33
C34
C35
Description
Grouped tumour streams
Malignant neoplasm of lip
Malignant neoplasm of base of tongue
Malignant neoplasm of other and unspecified
parts of tongue
Malignant neoplasm of gum
Malignant neoplasm floor of mouth
Malignant neoplasm of palate
Malignant neoplasm other and unspecified
parts of the mouth
Malignant neoplasms of parotid gland
Malignant neoplasm other and unspecific part
of salivary gland
Malignant neoplasm of tonsil
Malignant neoplasm of oropharynx
Malignant neoplasm of nasopharynx
Malignant neoplasm of pyriform sinus
Malignant neoplasm of hypopharynx
Malignant neoplasm of other and ill-defined
sites in the lip, oral cavity and pharynx
Malignant neoplasm of nasal cavity and middle
ear
Malignant neoplasm of accessory sinuses
Malignant neoplasm of larynx
Malignant neoplasm of thyroid gland
Secondary and unspecified malignant
neoplasms of lymph nodes of head, face and
neck
Malignant neoplasm of oesophagus
Malignant neoplasm of stomach
Malignant neoplasm of liver and intrahepatic
bile ducts
Malignant neoplasm of gallbladder
Malignant neoplasm of other and unspecific
parts of biliary tract
Malignant neoplasm of pancreas
Malignant neoplasm of small intestine
Malignant neoplasm of colon
Malignant neoplasm of rectosigmoid junction
Malignant neoplasm of rectum
Malignant neoplasm of anus and anal canal
Malignant neoplasm of other and ill-defined
digestive organs
Malignant neoplasm of trachea
Malignant neoplasm of bronchus and lung
Malignant neoplasm of thymus
Head and neck
Head and neck
Head and neck
Faster cancer treatment indicators – data definitions and reporting for the indicators
Head and neck
Head and neck
Head and neck
Head and neck
Head and neck
Head and neck
Head and neck
Head and neck
Head and neck
Head and neck
Head and neck
Head and neck
Head and neck
Head and neck
Head and neck
Head and neck
Head and neck
Upper gastrointestinal
Upper gastrointestinal
Upper gastrointestinal
Upper gastrointestinal
Upper gastrointestinal
Upper gastrointestinal
Lower gastrointestinal
Lower gastrointestinal
Lower gastrointestinal
Lower gastrointestinal
Lower gastrointestinal
Lower gastrointestinal
Lung
Lung
Lung
30
C38
C69
Malignant neoplasm of heart, mediastinum and
pleura, heart
Malignant neoplasm of other and ill-defined
sites in the respiratory system and intrathoracic
organs
Mesothelioma
Malignant neoplasm of bone and articular
cartilage of limbs
Malignant neoplasm of bone and articular
cartilage of other and unspecific sites
Kaposi’s sarcoma
Malignant neoplasm of retroperiotneum or
peritoneum
Malignant neoplasm of other connective or soft
tissue
Malignant melanoma of skin
Other malignant neoplasms of skin (except
basal cell carcinoma)
Malignant neoplasm of peripheral nervous and
autonomic nervous system
Malignant neoplasm of eye and adnexa
C70
Malignant neoplasm of meninges
C71
Malignant neoplasm of brain
C72
Malignant neoplasm of spinal cord, cranial
nerves and other parts of central nervous
system
Malignant neoplasm of breast
Malignant neoplasm of vulva
Malignant neoplasm of vagina
Malignant neoplasm of cervix uteri
Malignant neoplasm of corpus uteri
Malignant neoplasm of uterus, part unspecified
Malignant neoplasm of ovary
Malignant neoplasm of other and unspecified
female genital organs
Malignant neoplasm of placenta
Malignant neoplasm of penis
Malignant neoplasm of prostate
Malignant neoplasm of testis
Malignant neoplasm of other and unspecified
male genital organs
Malignant neoplasm of kidney, except renal
pelvis
Malignant neoplasm of renal pelvis
Malignant neoplasm of ureter
Malignant neoplasm of bladder
Malignant neoplasm of other and unspecified
urinary organs
Malignant neoplasm of adrenal gland
Malignant neoplasm of other endocrine glands
C39
C45
C40
C41
C46
C48
C49
C43
C44
C47
C50
C51
C52
C53
C54
C55
C56
C57
C58
C60
C61
C62
C63
C64
C65
C66
C67
C68
C74
C75
Faster cancer treatment indicators – data definitions and reporting for the indicators
Lung
Lung
Lung
Sarcoma
Sarcoma
Sarcoma
Sarcoma
Sarcoma
Skin
Skin
Brain / Central nervous
system
Brain / Central nervous
system
Brain / Central nervous
system
Brain / Central nervous
system
Brain / Central nervous
system
Breast
Gynaecological
Gynaecological
Gynaecological
Gynaecological
Gynaecological
Gynaecological
Gynaecological
Gynaecological
Urological
Urological
Urological
Urological
Urological
Urological
Urological
Urological
Urological
Other
Other
31
C76
C78
C79
C80
C97
C81
C83
C84
C85
C88
C90
C91
C92
C93
C94
C95
C96
and related structures
Malignant neoplasm of other and ill-defined
sites
Secondary malignant neoplasm of respiratory
and digestive organs
Secondary malignant neoplasm of other sites
Malignant neoplasm without specification of
site
Malignant neoplasms of independent (primary)
multiple sites
Hodgkin’s disease
Diffuse non-Hodgkin’s lymphoma
Peripheral and cutaneous T-cell lymphomas
Other and unspecified types of non-Hodgkin’s
lymphoma
Malignant immunoproliferative diseases
Multiple myeloma and malignant plasma cell
neoplasms
Lymphoid leukaemia
Myeloid leukaemia
Monocytic leukaemia
Other leukaemia of specified cell type
Leukaemia of unspecified cell type
Other and unspecified malignant neoplasms of
lymphoid, haematopoietic and related tissue
Faster cancer treatment indicators – data definitions and reporting for the indicators
Other
Other
Other
Other
Other
Haematological
Haematological
Haematological
Haematological
Haematological
Haematological
Haematological
Haematological
Haematological
Haematological
Haematological
Haematological
32