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30 days SACT UK Alfredo Addeo Lung NSSG 15th November 2016 Background • Cancer chemotherapy has been provided in the NHS for decades • Accurate, timely and complete data collection is now seen as a priority and this can be assisted by e-prescribing systems • The introduction of the Systemic Anti-Cancer Therapy (SACT) Information Standard (ISB 1533) • Collection and submission of SACT data is specifically incorporated in the England NHS Standard Contract SACT dataset applies to: All organisations providing cancer chemotherapy services in or funded by the NHS in England and includes: • • • • • all cancer patients, adult AND paediatric acute inpatient, daycase outpatient settings and delivery in the community; Includes oral chemotherapy Covers chemotherapy treatment for: • all solid tumours • haematological malignancies • and includes those in clinical trials SACT dataset • Consists of 6 sections across 42 data items: – – – – – – Demographics & Consultant Clinical Status Programme & Regimen Cycle Drug Details Outcome Who? Public Health England CKO Chief Knowledge Officer Disease Registration National Director for Disease Registration NCIN (PHE) Directors Dr Ken NCIN Lloyd and Sue Clinical Forsey Information Principal Specialists developers of the SACT CCIG Chemotherapy Clinical Information Group Pharmacist Support SACT Programme Board CIU Core Team SACT Programme Manager SACT Snr. PH Analyst SACT Trainer/Liaison SACT Senior Public Health Data Clerk SACT Project Manager SACT Senior Public Health Data Clerk SACT Systems Developer Allows additional scrutiny of clinical decisions Ineffective drug? or insufficient dose of effective drug? SACT Dataset young : old stage : performance status : co-morbidity Clinica l status age benefit - curative treatment - disease control - symptom control Optimal choice of clinical management for desired outcome toxicity Regimen & delivery recording regimen and detail correctly is critical - stopped early - dose modified - treatment delayed also: • To describe the level and variation of 30 day mortality following SACT on a national levelidentified as quality measurement tool • To highlight the potential to use SACT data to monitor and improve cancer patient care and outcomes and enhance the data quality and reporting by trusts to that end National SACT data • Published in the Lancet Oncology Sept 2016 • Data collected for patients treated between January – December 2014 • 28,400 women with breast cancer • 15,000 patients with lung cancer • NHS began submitting data in April 2012, and it became mandatory in April 2014 • This paper + companion report- 1st major output from this data source National SACT data SACT DATA 2014 • Palliative intent: • Breast – death within 30 days: 7.5% • Lung – 10% • Curative intent: • Breast – 0.3% • Lung – 2.9% National SACT data England’s 30-day chemotherapy mortality: a measure of quality of care? 1. despite this initiative to collate national data for cancer chemotherapy, there were significant gaps and deficiencies in the national dataset. 2. it remains a tragedy that we still cannot get complete national (anonymised) datasets to inform clinicians and patients and to drive real improvements in patient care. 3. This study sets a standard for what health-care systems should achieve: to routinely record, collate, and report at a national level the negative consequences of medical interventions to improve the quality of health care. Brest Cancer curative Figure 2 Funnel plot of variation in risk-adjusted 30-day mortality in patients with breast cancer given systemic anticancer therapy with curative intent, by hospital trust Each circle represents a separate hospital trust; blue and red circles represent outliers beyond the 95% and 99·8% confidence interval boundaries that are represented as grey lines. Red line shows national risk-adjusted 30-day mortality rate. NSCLC curative Figure 4 Funnel plot showing variation in risk-adjusted 30-day mortality in patients with non-small cell lung cancer given systemic anticancer therapy with curative intent, by hospital trust Each circle represents a separate hospital trust; blue and red circles represent outliers beyond the 95% and 99·8% confidence interval boundaries that are represented as grey lines. Red line shows national risk-adjusted 30-day mortality rate. NSCLC palliative Figure 5 Funnel plot showing variation in risk-adjusted 30-day mortality in patients with non-small cell lung cancer given systemic anticancer therapy with palliative intent, by hospital trust Each circle represents a separate hospital trust; blue and red circles represent outliers beyond the 95% and 99·8% confidence interval boundaries that are represented as grey lines. Red line shows national riskadjusted 30-day mortality rate. Summary of 30-day mortality rates in patients with breast or lung cancer by treatment intent Data are n (%) of total patients by cancer type and treatment intent; and n (%) of deaths occurring within 30 days of systemic anticancer therapy for each of those groups. 30-day mortality rates in patients with lung cancer by morphology and treatment intent Data are n (%) of total patients by lung cancer type and treatment intent; and n (%) of deaths occurring within 30 days of systemic anticancer therapy for each of those groups. NSCLC=non-small cell lung cancer. SCLC=small cell lung cancer. • 1st important insights into 30-day mortality in a large, representative population of patients with breast or lung cancer receiving systemic anticancer therapy in England. • Some trusts having significantly higher rates for early mortality, the reasons require further investigation Conclusion Media Reaction 1) NEW STUDY FINDS CHEMO KILLS 50% OF PATIENTS IN FIRST 30 DAYS 2) LANDMARK STUDY SHOWS HALF OF CANCER PATIENTS ARE KILLED BY CHEMO — NOT CANCER LIMITATIONS 1) Submission data mandatory only form april 2014. 2) Possible wrong coding. 3) SACT number for 2014 much lower than real? National SACT • Data being sent to PHE not a reflection of true 30 day mortality • Disparity in number of patients treated compared to national SACT data • Possible improvement with increased clinical engagement. Conclusions