Download Patients diagnosed with metastatic breast, lung and prostate

Patients diagnosed with
metastatic breast, lung and
prostate cancers on presentation
J Shield1, R Bowden1, J Flynn1, T Welchman2, E Drage2, M Gibbs2, C Edson2, M Lind3, M Lee4, R Kockelbergh5, J Maher1
1
Macmillan Cancer Support; 2Monitor Deloitte; 3Hull and East Yorkshire Hospitals NHS Trust; 4NHS England; 5Leicester General Hospital
Results
8,725 patients (11.5%) presented with metastatic cancer at the time of diagnosis, of whom
1,880 (21.5%) survived for at least one year after diagnosis.
RfD can also be used to investigate activity and resource usage. Patients presenting with
metastases at diagnosis were much more likely to have an emergency admission within ±10
days of diagnosis than those with no metastases recorded at presentation (Figure 3).
Average total inpatient cost per patient (from diagnosis until death or up to 7 years postdiagnosis) were also higher for patients presenting with metastases than for those without
metastases (Figure 4). However, the highest costs were for patients who developed metastases
more than 90 days after diagnosis, perhaps due to longer survival.
20%
10%
0%
Lung
£6,875
£13,344
£2,000
£5,838
£4,000
Metastases
Developed
Lung
Prostate
Breast
Lung
Prostate
Breast
Lung
Prostate
Breast
£0
Metastases
Presented
95.4
93.6
89.6
Prostate
Breast
Figure 2: Proportion of patients aged over 75,
by tumour group and presence of metastases at diagnosis
57.9
60%
All patients
50%
Patients presenting with metastases at diagnosis
40%
30%
31.2
20%
10%
0%
Lung
Prostate
Breast
Figure 3: Emergency admissions within 10 days of diagnosis,
among patients with and without metastases at presentation
Lung
No metastases
recorded at
presentation
Metastases
present at
diagnosis
37.3%
55.5%
62.7%
44.5%
Prostate
5.3%
57.6%
94.7%
42.4%
Breast
3.0%
38.4%
97.0%
61.6%
Emergency admission
within ±10
days of diagnosis
Yes
No
Studies using comprehensive local data report higher proportions of patient’s experiencing
metastases.2 Comprehensive national data is required if the full picture of metastatic data is to
be understood.
£8,330
£6,000
£7,704
£8,000
£10,107
£10,000
£11,960
£12,000
£12,105
£18,717
£14,000
28.2
30%
Earlier diagnosis is essential if the UK is to match Europe’s best cancer outcomes. Late
diagnosis disproportionately affects older and deprived populations; findings that mirror
NCIN’s Routes to Diagnosis.1
£20,000
£16,000
42.3
40%
51.7
50%
Conclusion
Figure 4: Average total inpatient cost per patient, by tumour group
and presence or subsequent development of metastases
£18,000
90.1
60%
30.0%, 4.6% and 3.7% of lung, prostate and breast cancer patients respectively presented
with metastatic cancer at diagnosis. Survival rates among these groups were far lower than
among patients who had no metastases (Figure 1).
Breast and prostate cancer patients with metastases at diagnosis were more likely than
the average for each cancer type to be aged 75+ (Figure 2), and 32.7% and 18.2% more
likely than average to be among the most deprived quintile. However, lung cancer patients
presenting with metastases at diagnosis did not follow this trend.
No recorded metastases
20.8
All activity in inpatient HES was costed using HRG codes. This included all episodes of
admitted care including elective, non-elective, day cases and regular attendances.
70%
39.6
The team identified a distinction between patients presenting with and subsequently
developing metastases, based upon the point in time at which a diagnosis of metastatic cancer
was recorded. A patient is defined as presenting with metastases if their first metastatic event
occurs with 90 days of their cancer diagnosis date.
Metastases subsequently developed
32.7
Coding of stage (and therefore metastases) at diagnosis was poor, with only 67.3%,
23.1% and 20.6% coverage of NCDR stage variables for breast, prostate and lung cancer
respectively in the RfD data set. As it is common for metastases to be coded as new primary
tumours, rather than using only ‘metastatic’ ICD-10 codes to identify metastases, all instances
of ICD-10 codes C77-79 (malignant neoplasms of ill-defined, secondary and unspecified
sites) and tumours coded at common metastatic sites for breast, prostate and lung cancer
(lungs (C34), liver (C22), bones (C40-41), adrenal gland (C74) and brain (C70-72))
were coded in the RfD dataset as metastases where patients already had a primary breast,
prostate or lung tumour in NCDR. HES data is used for the coding of metastases and captures
significantly more metastases than using NCDR stage at diagnosis.
80%
55.1
Clinical experts and data analysts collaborated to map out cancer journeys for patients diagnosed
with breast (n = 26,926), lung (21,634) and prostate (27,213) cancers in England in 2004.
Metastases present at diagnosis
39.8
Method
90%
12.5
Applying these methods to the three most common cancers – breast, lung and prostate – we
aimed to investigate the characteristics of patients presenting with metastases at diagnosis.
100%
Patients surviving to 1 year (%)
‘Routes from Diagnosis’ (RfD) links and analyses routinely collected cancer registry and HES
data to map out the cancer journey for whole cohorts of patients up to 7 years after diagnosis.
This approach brings together information on survival, morbidities, activity, cost and
demographics, painting a detailed picture of survivorship.
Figure 1: 1-year survival rates by tumour group and
presence or subsequent development of metastases
Patients aged 75+ (%)
Background
No Metastases
Overall, RfD demonstrates the extent of insights it is possible to derive from analysis of
routinely collected data, ranging from clinical outcomes to activity and costs.
References
1
Elliss-Brookes et al., Routes to diagnosis for cancer – determining the patient journey using multiple routine data sets,
British Journal of Cancer (2012)
2
Walkington, L et al., Patterns of breast cancer recurrence and associated health care costs of 1000 patients treated in Leeds:
a longitudinal study, NCIN Cancer Outcomes Conference poster presentation (2012)
In partnership with:
For further findings, see Routes from
Diagnosis: the most detailed map of
cancer survivorship yet
national cancer
intelligence network
Macmillan Cancer Support, registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). MAC15208
bit.ly/macmillanrfd