Download FCT Data Definitions - Central Cancer Network

Faster cancer treatment indicators:
Data definitions and reporting for
the indicators
Date:
15 October 2012
Version:
2
Ministry of Health
Cancer Services
Final
Owner:
Status
1
Contents
Purpose...................................................................................................................................... 3
Faster cancer treatment indicators ........................................................................................... 4
Rationale ................................................................................................................................ 4
Reporting against the FCT indicators ........................................................................................ 5
Retrospective reporting .......................................................................................................... 5
Data collection responsibility .................................................................................................. 6
Data reporting process ........................................................................................................... 6
Inclusions and exclusions for the FCT indicators ....................................................................... 7
Inclusions ............................................................................................................................... 7
Exclusions .............................................................................................................................. 8
Reportable data items for the FCT indicators ........................................................................... 9
Mandatory data items............................................................................................................. 9
Conditional ............................................................................................................................. 9
Non-mandatory data items ..................................................................................................... 9
Clock start and stop times for the FCT indicators ................................................................... 10
Appendix A: FCT indicators in practice – use cases ................................................................ 11
Appendix B: Definitions of the mandatory data items ........................................................... 22
Appendix C: Definitions of the conditional and non-mandatory data items ......................... 29
Appendix D: Primary site ICD.................................................................................................. 33
2
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 provides the updated 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).
 National Health Index Data Dictionary v5.3 (July 2009)
3
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: a referral to a specialist and the triaging clinician considers the person
needs to be seen within two weeks to maximise the potential benefit of treatment for that
person.
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 and / or other
clinical findings.
4
See Appendix B: Definitions of the mandatory data items, page 22.
4
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 all DHBs at the end of quarter
three 2012/13 for the period 1 January 2013 to 31 March 2013. DHBs are expected
to begin collecting baseline data on the FCT indicators during 2012/13, those DHBs
who are able to report data earlier than quarter three 2012/13 are encouraged to do
so.
Retrospective reporting
The reporting to the Ministry on the FCT indicators data will be retrospective5. This is
because the initial focus is on routinely collecting baseline data on the three FCT
indicators across the tumour types.
DHBs can establish their data collection and reporting systems to collect information
on patients as patients track through the care pathway (ie prospectively). This
information is then reported retrospectively to the Ministry at the time that the patient
has started their first treatment.
During 2012/13 the FCT indicators are reported retrospectively to the Ministry
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.
5
Retrospective means that reporting the length of time it takes for each patient against the
FCT indicators happens once the patient has started their first treatment.
5
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 collecting and collating information on the
data items and submitting this information via the reporting template to the Ministry,
see Data reporting process on page six.
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 can be:


collected via the FCT data collection template available on the nationwide
service framework library www.nsfl.health.govt.nz. This is a simple excel
spreadsheet
reported via a pipe delimited text file and must be submitted to the Ministry
via secure File Transfer Protocol (FTP).
Ideally, all data is reported monthly and reaches the Ministry within 20 days of the
end of the month in which the patient’s first treatment took place. However, the
minimum requirement is for data to be reported within 20 days of the end of the
quarter.
The initial focus is on collecting baseline information and adjustments may be made
to the data collection template, text file requirements or reporting frequency if
required.
6
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 one applies to patients who:
 are referred urgently, or triaged as urgent, with a high-suspicion of cancer
 have a confirmed diagnosis of cancer at decision-to-treat
 have a first cancer treatment, an active decision for no treatment is also
included see definitions for first treatment.
Indicator two applies to patients who:
 are referred urgently, or triaged as urgent, with a high-suspicion of cancer
 have a confirmed diagnosis of cancer at decision-to-treat
 have a first specialist assessment.
Indicator three8 applies to patients who:
 are reported in indicators one and two
 have a pre decision-to-treat pathway outside the New Zealand public
health system and the patient is then referred to the public health system
for treatment, and the patient has a confirmed diagnosis of cancer at
decision-to-treat
 have their cancer detected as an incidental finding for example, as a
result of a positive screening test that is then follow-up and results in a
confirmed diagnosis of cancer at decision-to-treat.
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 and / or other clinical 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.
7
Exclusions
Patients are excluded from the three 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 for
example, the patient is admitted for surgery with suspected bowel
obstruction and at surgery the patient is identified as having cancer which
is removed (see use case eight for further information)
 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.
Patients are excluded from indicator one if:
 the triaging clinician deems the referral is not an urgent referral with a
high-suspicion of cancer
 do not have a confirmed diagnosis of cancer at decision-to-treat.
Patients are excluded from indicator two if:
 the triaging clinician deems the referral is not an urgent referral with a
high-suspicion of cancer
 they do not have a confirmed diagnosis of cancer at decision-to-treat
 they do not have a first specialist assessment (in some cases patients
attend a routine new appointment instead of a first specialist assessment,
where the routine new appointment is effectively a first specialist
assessment the patient is still counted in indicator two).
Patients are excluded for indicator three if they:
 do not have a confirmed diagnosis of cancer at decision-to-treat.
8
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
National Health Index (NHI) number
Family name
Date of birth
Sex
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)9
Date of decision-to-treat
Type of first treatment
DHB of service for first treatment
Date of first treatment
Indicator/s
All
All
All
All
All
1, 2
1, 2
2
All
1, 3
1, 3
1, 3
1, 3
Conditional
The conditional data items to be reported to the Ministry for the three FCT indicators
are identified in the following table, see also Appendix C: Definitions of the
conditional and non-mandatory data items.
Field
Delay code 1
Delay code 2
Delay code 3
Indicator/s
1
2
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. These data items are currently non-mandatory, 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 conditional and non-mandatory data items.
Field
First name
Source of referral10
Date patient informed of diagnosis
Date of multidisciplinary meeting (MDM)
Urgency of referral
9
Indicator/s
All
1, 2
1, 2
1, 3
1, 2
See Appendix D for a list of included primary site ICDs.
10
Includes acute and elective sources of referral.
9
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.
11
Clock start
Clock stop
The date of receipt of referral
that led to the patient being
diagnosed with cancer.
The date that the patient had
their first treatment (or other
management).11
The date of receipt of referral
for the first specialist
assessment that 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.
10
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
.
11
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.
12
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 chemotherapy12 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
.
12
The Shorter waits for cancer treatment health target includes outpatient chemotherapy from
1 July 2012.
13
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.
14
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
.
15
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.
16
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
.
17
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
DHB of
domicile is
responsible
for collecting
information
from the
DHB of
service
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.
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
.
19
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.
20
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 adjuvant13 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.
13
Adjuvant treatment is treatment that is given in addition to the primary, main or initial
treatment.
21
Appendix B: Definitions of the mandatory data items
National Health Index (NHI) number definition
Definition:
The NHI is a unique 7-character identification number assigned to a
healthcare user by the NHI database.
Source standards:
National Health Index Data Dictionary v5.3 (July 2009).
Obligation:
Mandatory
Field Name
NHI_Number
Guide for use:
The NHI number is the primary key for the faster cancer treatment
record.
Family name definition
Definition:
The family name (surname) of a healthcare user.
Source standards:
National Health Index Data Dictionary v5.3 (July 2009).
Obligation:
Mandatory
Field Name:
Family_Name
Guide for use:
N/A
Date of birth definition
Definition:
The date of birth is the date on which the healthcare user was born.
Source standards:
HL7 v2.4 DT – date.
Obligation:
Mandatory
Data domain:
Valid date
Field Name:
Date_of_Birth
Guide for use:
N/A
22
Sex definition
Definition:
Sex is the person’s biological sex
Source standards:
National Health Index Data Dictionary v5.3 (July 2009).
Obligation:
Mandatory
Data domain:
Field Name:
Sex
Guide for use:
N/A
Value
Meaning
F
I
M
U
Female
Indeterminate
Male
Unknown
DHB of domicile definition
Definition:
The DHB of domicile is the code of the DHB responsible for the
domicile.
Source standards:
National Health Index Data Dictionary v5.3 (July 2009).
Obligation:
Mandatory
Value
Data domain:
011
021
022
023
031
042
047
051
061
071
081
082
091
092
093
101
111
121
123
160
Field Name:
DHB_of_ domicile
Guide for use:
N/A
Meaning
Northland
Waitemata
Auckland
Counties Manukau
Waikato
Lakes
Bay of Plenty
Tairawhiti
Hawkes Bay
Taranaki
MidCentral
Whanganui
Capital and Coast
Hutt Valley
Wairarapa
Nelson Marlborough
West Coast
Canterbury
South Canterbury
Southern
23
Date of 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.
Source standards:
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.
National Cancer Core Data Definitions Interim Standard HISO
10038.3 October (2011).
HL7 v2.4 DT – date.
Obligation:
Mandatory
Data domain:
Valid date
Field Name:
Date_of_receipt_of_referral
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.
24
DHB of receipt of referral definition
Definition:
The DHB of receipt of referral is the code of the DHB that received the
initial referral.
Source standards:
National Health Index Data Dictionary v5.3 (July 2009).
Obligation:
Mandatory
Data domain:
Valid 3-digit DHB code (refer to DHB of domicile definition).
Field Name:
DHB_of_receipt_of_referral
Guide for use:
On occasion, there will be multiple referrals for an individual patient.
Where a patient has been referred from one DHB to another DHB the
code to be used here is for the DHB that received the referral that
initiated the treatment for cancer.
Date of first specialist assessment definition
Definition:
The date of the patient’s first specialist assessment for the urgent
referral with a high-suspicion of cancer.
Source standards:
National Health Index Data Dictionary v5.3 (July 2009).
HL7 v2.4 DT – date.
Obligation:
Mandatory
Data domain:
Valid date
Field Name:
Date_of_FSA
Guide for use:
N/A
25
Primary site International Classification of Diseases (ICD) definition
Definition:
The Primary site ICD is the code that describes the primary site of the
cancer for which the patient is being seen.
Source standards:
National Health Index Data Dictionary v5.3 (July 2009).
Obligation:
Mandatory
Data domain:
Valid ICD (10th edition) codes recorded to the third digit (see appendix
D).
Field Name:
Primary_Site
Guide for use:
The 3 digit ICD10 code forms part of the primary key for the faster
cancer treatment record.
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).
Obligation:
Mandatory
Data domain:
Valid date
Field Name:
Date_of_Decision_to_treat
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-to-treat.
26
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).
Obligation:
Data domain:
Mandatory
Value
00
01
02
03
04
05
06
07
08
99
Meaning
Other
Surgery: exclude diagnostic procedures such as punch,
incisional, needle or core
Radiation therapy
Chemotherapy
Targeted therapy: refers to a medication / drug that targets a
specific pathway in the growth and development of a tumour
Non-intervention management: an expectant approach
pending change in the patient’s circumstances. It is a period of
active management not unmanaged non-treatment
Palliative care: an active decision for palliative care
Patient refused treatment
Patient died before treatment
Not recorded
Field Name:
Type_of_First_Treatment
Guide for use:
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 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.
27
DHB of service for first treatment definition
Definition:
The DHB of service for first treatment is the code of the DHB that
provided the patient’s first cancer treatment.
Source standards:
National Health Index Data Dictionary v5.3 (July 2009).
Obligation:
Mandatory
Data domain:
Valid 3-digit DHB code (refer to DHB of domicile definition).
Field Name:
DHB_of_First_Treatment
Guide for use:
This is the DHB that provided the first treatment recorded in the type
of first treatment field. 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
Where first treatment is a clinical trial, the DHB of first treatment is
considered to the DHB where the patient was enrolled in the clinical
trial.
Where first treatment is targeted therapy – hormone therapy, the DHB
of first treatment is considered to be the DHB where the prescription is
written for the treatment.
Date of first treatment definition
Definition:
The date for first treatment is the date that first treatment was provided
for that patient for that cancer.
Source standards:
HL7 v2.4 DT – date.
Obligation:
Mandatory
Data domain:
Valid date
Field Name:
Date-of_First_Treatment
Guide for use:
The date of first treatment is the date the first treatment was provided
or attempted but not carried out or completed for clinical reasons. For
example ‘open and shut surgery’ would be coded under 01 surgery.
Where a patient’s diagnostic biopsy is included as first treatment,
because the whole tumour has been removed and the margins are
clear, the date of the biopsy is the date of first treatment.
Where first treatment is a clinical trial, the date of first treatment is the
date the patient was enrolled 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.
28
Appendix C: Definitions of the conditional and non-mandatory
data items
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. There can be a
separate delay code for each indicator, stored in three individual fields
representing the 3 indicators.
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).
Obligation:
Conditional
Data domain:
Value
00
01
02
03
04
05
06
07
08
09
98
99
Field Names:
Meaning
Other
Capacity constraint resulting from lack of resources
(theatre, equipment, facilities or workforce) 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
Delay_code_1
Delay_code_2
Delay_code_3
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.
If it is required there can be a delay code for each indicator (i.e. the
delay code relating to indicator 1 should be stored in the
‘Delay_code_1’ field)
29
First name definition
Definition:
The first given name of a healthcare user.
Source standards:
National Health Index Data Dictionary v5.3 (July 2009).
Obligation:
Non-mandatory
Data domain:
N/A
Field Name:
First_Name
Guide for use:
N/A
Source of referral definition
The source of the referral is defined by the facility / health professional that
Definition:
made the referral.
Source
standards:
National Health Service Scotland New Cancer Waiting Times Targets Data
and Definitions Manual (2010).
Obligation:
Non-mandatory
Data domain:
Value
00
01
02
03
04
05
06
07
08
09
Meaning
Other
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
Field Name
Source_of_Referral
Guide for use:
N/A
30
Date of 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).
Obligation:
Non-mandatory
Data domain:
Valid date
Field Name:
Date_of_diagnosis
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).
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.
31
First multidisciplinary meeting (MDM) 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).
Obligation:
Non-mandatory
Data domain:
Valid date
Field Name:
Date_of_First_MDM
Guide for use:
N/A
Urgency of referral definition
Definition:
To be advised
Source
standards:
National Health Index Data Dictionary v5.3 (July 2009).
Obligation:
Non-mandatory
Data domain:
To be advised
Field Name:
Urgency_of_referral
Guide for use:
To be advised
32
Appendix D: Primary site ICD
The ICD codes (10th Edition) should be recorded to the third digit for all cancers. The
ICD codes to be reported are provided in the following table. Note that D codes are
excluded from the FCT indicators because they relate to cancers that are low-risk, or
non-invasive, or non-malignant, or low-grade, asymptomatic or indolent.
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
C37
C38
C39
C45
C40
C41
Description
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
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
33
ICD codes
to third digit
C46
C48
C49
C43
C47
C69
C70
C71
C72
C50
C51
C52
C53
C54
C55
C56
C57
C58
C60
C61
C62
C63
C64
C65
C66
C67
C68
C74
C75
C76
C78
C79
C80
C81
C83
C84
C85
C88
C90
C91
C92
C93
C94
C95
C96
Description
Kaposi’s sarcoma
Malignant neoplasm of retroperiotneum or peritoneum
Malignant neoplasm of other connective or soft tissue
Malignant melanoma of skin
Malignant neoplasm of peripheral nervous and autonomic nervous system
Malignant neoplasm of eye and adnexa
Malignant neoplasm of meninges
Malignant neoplasm of brain
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 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
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
34