Download Encore - London Cancer

Breast Screening Clinical Forum
Pan London Event
Welcome
Screening data for 2013/14
Louise Wilkinson – Director, South West London Breast Screening service
Mr Anil Desai- Consultant Oncoplastic and Reconstructive Breast Surgeon
Neera Patel - Consultant Pathologist and QA pathologist for London
QA Clinical Team
Breast Screening Study Day
Tuesday 16th December 2014
Annual Results Summary 2013-14 data
Operated by Public Health England
Presenters
Mr Anil Desai, Dr Louise Wilkinson, Dr Neera Patel
Commentators
Sarah Pinder
5
12/13
13/14
No of women invited
342535
368362
No of women screened (incl referrals)
229010
246694
No of Cancers diagnosed
1910
2013
No of Cancers Aged 65 plus
604
683
Breast Study Day 2014
Operated by Public Health England
Source: KC62 – All Ages – Table T
6
Breast Study Day 2014
Operated by Public Health England
358
276
313
181
181
199
200
232
361
81
358
81
347
Source: KC62
7
Breast Study Day 2014
Operated by Public Health England
428
358
276
313
181
181
199
200
232
361
81
358
322
81
347
Source: KC62
8
Breast Study Day 2014
Operated by Public Health England
Source: BASO
9
Breast Study Day 2014
Operated by Public Health England
Source: BASO
10
Breast Study Day 2014
Operated by Public Health England
428
358
276
313
181
181
199
200
232
361
81
358
322
81
347
Source: KC62
11
Breast Study Day 2014
Operated by Public Health England
428
358
276
313
181
181
199
200
232
361
81
358
322
81
347
Source: KC62
12
Breast Study Day 2014
Operated by Public Health England
358
276
313
181
181
199
200
232
361
81
358
322
81
347
Source: KC62
13
Breast Study Day 2014
Operated by Public Health England
428
358
276
313
181
181
199
200
232
361
81
358
81
347
Source: BASO
14
Breast Study Day 2014
Operated by Public Health England
Source: BASO
15
Breast Study Day 2014
Operated by Public Health England
Source: KC62
16
Breast Study Day 2014
Operated by Public Health England
Source: KC62
17
Breast Study Day 2014
Operated by Public Health England
Source: KC62
18
Breast Study Day 2014
Operated by Public Health England
Source: BASO
19
Breast Study Day 2014
Operated by Public Health England
Source: BASO
20
Breast Study Day 2014
Operated by Public Health England
Source: BASO
21
Breast Study Day 2014
Operated by Public Health England
Source: BASO
22
Breast Study Day 2014
Operated by Public Health England
Source: BASO
23
Breast Study Day 2014
Operated by Public Health England
Source: BASO
24
Breast Study Day 2014
Operated by Public Health England
Source: BASO
25
Breast Study Day 2014
Operated by Public Health England
Source: BASO
26
Breast Study Day 2014
Operated by Public Health England
Source: BASO
27
Breast Study Day 2014
Operated by Public Health England
Source: BASO
28
Breast Study Day 2014
Operated by Public Health England
Source: BASO
29
Breast Study Day 2014
Operated by Public Health England
Source: BASO
30
Breast Study Day 2014
Operated by Public Health England
Source: BASO
31
Breast Study Day 2014
Operated by Public Health England
Questions
The Development of a National Cancer
Registration Service for England
Barry Plewa
Deputy Head of Registration
NCRS London
The National Cancer Registration
Service for England
Barry Plewa
Deputy Head of Registration
NCRS London
National Cancer Registration Service
Northern and Yorkshire
NCRS Regional
Offices
North West
East Midlands
160+ Trusts
submitting to NCRS
West Midlands
Eastern
Oxford
London
South West
*
35
The National Cancer Registration Service for England
National Cancer Registration Service
8 Regional Cancer Registries now incorporated into a National Cancer
Registration Service for England
1 Director, 8 local offices
Complete migration ‘normalisation’ of 8 legacy systems with 11m cancer
registrations to ENCORE
Same practice and processes, single national system
Standardised data, consistency, comparability & efficiency
36
The National Cancer Registration Service for England
Dimensions of the Service
PID data collected under s.251 of the NHS Act on all diagnosed cancers in
England
Monthly data captured from 160+ NHS Providers (MDT, PAS, Path, Imaging)
Periodic data feeds from national sources (e.g. CWT, HES, ONS, HQIP Audits)
1700 MDTs per week,
200k records per month,
350k tumour registrations per year
42 cancer types
188 data items on the simplest cases of cancer
11 million cancer registrations over 50 years
37
The National Cancer Registration Service for England
Trust Data Streams to Regional Office
Radiotherapy
COSD / MDT
PAS
NHS Acute Trust
Radiology
38
Audit
Regional Office
Pathology
CWT
Chemo
Introducing the Cancer Data Liaison Team | Public Health England | May 2014
COSD Data
The primary area of focus for most improvement
work during and before 2013.
Radiotherapy
COSD / MDT
PAS
NHS Acute Trust
Radiology
39
Audit
Regional Office
Pathology
Encore
CWT
Chemo
Introducing the Cancer Data Liaison Team | Public Health England | May 2014
PAS, Pathology & Radiology
Radiotherapy
COSD / MDT
PAS
NHS Acute Trust
Radiology
40
Audit
Regional Office
Pathology
Encore
CWT
Chemo
Introducing the Cancer Data Liaison Team | Public Health England | May 2014
RTDS
Radiotherapy
Reviewing a new project aiming for direct data
feeds from Radiotherapy to NCRS.
Radiotherapy
COSD / MDT
PAS
NHS Acute Trust
Radiology
41
Audit
Regional Office
Pathology
Encore
CWT
Chemo
Introducing the Cancer Data Liaison Team | Public Health England | May 2014
RTDS
Audit and CWT
Radiotherapy
COSD / MDT
PAS
NHS Acute Trust
Radiology
42
Audit
Regional Office
Pathology
Encore
CWT
Open Exeter
Chemo
Introducing the Cancer Data Liaison Team | Public Health England | May 2014
RTDS
Chemotherapy
Radiotherapy
COSD / MDT
PAS
NHS Acute Trust
Radiology
43
Audit
Regional Office
Pathology
Encore
CWT
Open Exeter
Chemo
SACT
Introducing the Cancer Data Liaison Team | Public Health England | May 2014
RTDS
Death Certificates
Radiotherapy
COSD / MDT
Death Cert
ONS
PAS
NHS Acute Trust
Radiology
44
Audit
Regional Office
Pathology
Encore
CWT
Open Exeter
Chemo
SACT
Introducing the Cancer Data Liaison Team | Public Health England | May 2014
Screening Histories Information
Manager (SHIM)
Emily Steggall
Consultant in Public Health and Lead for Screening
Histories, ESQA
What is SHIM?
Links breast screening and breast cancer information
Automates process of assigning screening status to breast tumours (NCRS QA
measure)
Developed East of England: national system in development
Burns and Frances reports
Efficient, accurate, consistent (manual process where needed)
Timely, all-age (47+) interval cancer ascertainment
PHE: opportunity to reduce border issues
The System
Encore
Open Exeter
NBSS
• Process
starts with
file from
NCRS
• File sent to
NBSS and
Open Exeter
• Information
loaded into
SHIM
(manual)
• SHIM
analyses
data
Vision for National System
Public Health England
1. New
Tumours
6. Screening
status
National Cancer
Registration
Service
SHIM
4. Email alert
5. Confirmed
status
QARC
review
Secure role and location based
access and or report generation
SHIM direct
access to
NBSS
London Staging Completeness - 2012
Full Stage
Percentage
London Staging Completeness - 2013
Full Stage
Percentage
70% Target
London Staging Completeness - 2014
Full Stage
Percentage
70% Target
Cancer Registration - 2012/13
Completed December 2013
Staging Completeness 80% across PHOF
tumour sites – Prostate, Breast, Lung,
Colorectal and Ovary
Enabling national analysis that was previously
impossible
NCRS/NCIN publication
Cancer survival in England by Stage for 2012
2013 data due to be complete by the end of
2014 – Staging Completeness 80%+ across 11
tumours sites.
52
COSD Reporting | Public Health England | 2014
The National Cancer Registration
Service for England
Barry Plewa – Deputy Head of Registration
NCRS London
National Cancer Registration Service
Northern and Yorkshire
NCRS Regional
Offices
North West
East Midlands
160+ Trusts submitting
to NCRS
West Midlands
Eastern
Oxford
London
South West
*
54
The National Cancer Registration Service for England
National Cancer Registration Service
8 Regional Cancer Registries now incorporated into a National Cancer
Registration Service for England
1 Director, 8 local offices
Complete migration ‘normalisation’ of 8 legacy systems with 11m cancer
registrations to ENCORE
Same practice and processes, single national system
Standardised data, consistency, comparability & efficiency
55
The National Cancer Registration Service for England
Dimensions of the Service
PID data collected under s.251 of the NHS Act on all diagnosed cancers in
England
Monthly data captured from 160+ NHS Providers (MDT, PAS, Path, Imaging)
Periodic data feeds from national sources (e.g. CWT, HES, ONS, HQIP Audits)
1700 MDTs per week,
200k records per month,
350k tumour registrations per year
42 cancer types
188 data items on the simplest cases of cancer
11 million cancer registrations over 50 years
56
The National Cancer Registration Service for England
Trust Data Streams to Regional Office
Radiotherapy
COSD / MDT
PAS
NHS Acute Trust
Radiology
57
Audit
Regional Office
Pathology
CWT
Chemo
Introducing the Cancer Data Liaison Team | Public Health England | May 2014
COSD Data
The primary area of focus for most improvement
work during and before 2013.
Radiotherapy
COSD / MDT
PAS
NHS Acute Trust
Radiology
58
Audit
Regional Office
Pathology
Encore
CWT
Chemo
Introducing the Cancer Data Liaison Team | Public Health England | May 2014
PAS, Pathology & Radiology
Radiotherapy
COSD / MDT
PAS
NHS Acute Trust
Radiology
59
Audit
Regional Office
Pathology
Encore
CWT
Chemo
Introducing the Cancer Data Liaison Team | Public Health England | May 2014
RTDS
Radiotherapy
Reviewing a new project aiming for direct data
feeds from Radiotherapy to NCRS.
Radiotherapy
COSD / MDT
PAS
NHS Acute Trust
Radiology
60
Audit
Regional Office
Pathology
Encore
CWT
Chemo
Introducing the Cancer Data Liaison Team | Public Health England | May 2014
RTDS
Audit and CWT
Radiotherapy
COSD / MDT
PAS
NHS Acute Trust
Radiology
61
Audit
Regional Office
Pathology
Encore
CWT
Open Exeter
Chemo
Introducing the Cancer Data Liaison Team | Public Health England | May 2014
RTDS
Chemotherapy
Radiotherapy
COSD / MDT
PAS
NHS Acute Trust
Radiology
62
Audit
Regional Office
Pathology
Encore
CWT
Open Exeter
Chemo
SACT
Introducing the Cancer Data Liaison Team | Public Health England | May 2014
RTDS
Death Certificates
Radiotherapy
COSD / MDT
Death Cert
ONS
PAS
NHS Acute Trust
Radiology
63
Audit
Regional Office
Pathology
Encore
CWT
Open Exeter
Chemo
SACT
Introducing the Cancer Data Liaison Team | Public Health England | May 2014
Screening Histories Information
Manager (SHIM)
Emily Steggall
Consultant in Public Health and Lead for Screening
Histories, ESQA
What is SHIM?
Links breast screening and breast cancer information
Automates process of assigning screening status to breast tumours
(NCRS QA measure)
Developed East of England: national system in development
Burns and Frances reports
Efficient, accurate, consistent (manual process where needed)
Timely, all-age (47+) interval cancer ascertainment
PHE: opportunity to reduce border issues
65
The System
Encore
• Process starts with file
from NCRS
• File sent to NBSS and
Open Exeter
Open Exeter
• Information loaded
into SHIM (manual)
• SHIM analyses data
National Breast
Screening Service
66
SHIM
1. New
Tumours
6. Screening
Status
SHIM
NCRS
5. Screening status
confirmed
The SHIM
Cycle
2. NHS Number
trace
SHIM
QARC
68
4. E-mail alert
3. Screening
Data
East of England Cancer Screening QA Cervical Data Management 24th Nov 2011
NBSS
SHIM Interface
69
The National Cancer Registration Service for England
SHIM
QARCs
Screening
NBSS
Radiotherapy
RTDS
COSD / MDT
Death Cert
ONS
PAS
NHS Acute Trust
Radiology
70
Audit
Regional Office
Pathology
Encore
CWT
Open Exeter
Chemo
SACT
Introducing the Cancer Data Liaison Team | Public Health England | May 2014
Connection Status
Barking, Havering, Redbridge & Brentwood Breast
Screening Service
Central & East London Breast Screening Service
North London Breast Screening Service
South West London Breast Screening Service

South East London Breast Screening Service
West London Breast Screening Service
71
East of England Cancer Screening QA Cervical Data Management 24th Nov 2011

SHIM Contacts
SHIM Project Manager
Emily Steggall
[email protected]
SHIM Developer
Graham Phillips
[email protected]
NCRS Contact
James Withers
72
The National Cancer Registration Service for England
[email protected]
73
The National Cancer Registration Service for England
Data Improvement – 2012 Staging Data
Full Stage
Percentage
Data Improvement – 2013 Staging Data
Full Stage
Percentage
70% Target
Data Improvement – 2014 Staging Data
Full Stage
Percentage
70% Target
Cancer Registration - 2012/13
2012 Data completed December 2013
Staging Completeness 80% across PHOF tumour
sites – Prostate, Breast, Lung, Colorectal and Ovary.
11 tumour sites for 2013 and all tumour sites from
2014 onwards.
Enabling national analysis that was previously
impossible - NCRS/NCIN publication
Cancer survival in England by Stage for 2012
2013 data due to be complete by the end of 2014 –
Staging Completeness 80%+ across 11 tumours
sites.
2015 data to be processed in “real time” –
notification within 2 months, full record within 8
months.
87
COSD Reporting | Public Health England | 2014
Questions
Overtreatment of DCIS The LORIS trial
Adele Francis
Consultant Surgeon University Hospital Birmingham, Royal College
Surgeons Specialty Lead for Breast Research
The Low Risk DCIS Trial
Overdiagnosis of DCIS
• Over diagnosis is diagnosing healthy women
with ‘breast cancer’ who would never otherwise
have acquired a breast cancer diagnosis in their
lifetime
The Breast Screening Review
2012
• Not Just a UK issue
94
• In January 2013, the Swiss Medical Board, an
independent health technology assessment
initiative was mandated to prepare a review of
mammography screening.
95
Findings
• ‘No clear evidence of any survival benefit
• RECOMMENDATION
• No new breast screening programmes should
be started and the current one wound down.
96
97
Stage specific incidence of
breast cancer in USA
The Low Risk DCIS Trial
• If Patient is confirmed as eligible then
the Full Patient Information Document
will be given to the patient along with
the complimentary DVD (evenhanded).
PATIENT RANDOMISED TO STANDARD
TREATMENT ARM
•
EXACTLY THE SAME TREATMENT AS THEY WOULD HAVE
HAD BEFORE THE TRIAL OPENED.
• SURGERY IS THE SAME
• ANY LOCALLY PROTOCOLISED ADJUVANT TREATMENT &
FOLLOW UP IS THE SAME
• ANNUAL MAMMOGRAMS
PATIENT RANDOMISED TO
ACTIVE MONITORING ARM
• Active monitoring with annual
mammograms
Primary Outcome
• Ipsilateral invasive breast cancer free survival
rate at 5 years
Pilot Sites
Principal Investigator
Matthew Wallis
Fiona Hoar
Mike Dean
Michael Douek
PG Roy
Jonathan Roberts
Andy Evans
Lisa Whisker
Simon Holt
Michaela Stahnke
Mike King
Adele Francis
Jane Ooi
Philip Drew
Mark Sibbering
Douglas Ferguson
Malcolm Reed
Charles Zammit
Nadir Khonji
Neil Rothnie
Raj Achuthan
Steve Parker
Soni Soumian
Nigel Bundred
Hospital
Addenbrooke's Hospital
City Hospital
Crosshouse Hospital
Guy's and St Thomas
John Radcliffe Hospital
King's College Hospital
Ninewells Hospital and Medical School
Nottingham Hospital
Prince Phillip Hospital
Princess Ann Hospital, Southampton
Queen Alexandra Hospital
Queen Elizabeth, Birmingham
Royal Bolton Hospital
Royal Cornwall Hospital
Royal Derby Hospital
Royal Devon & Exeter Hospital
Royal Hallamshire Hospital
Royal Sussex County Hospital
Royal Victoria Infirmary
Southend University Hospital
St James's University Hospital
University Hospital Coventry and Warwickshire
University Hospital of North Staffordshire NHS Trust
University Hospital of South Manchester
[email protected]
Trial co-ordinator
Jennie Young
Questions
Managing moderate risk family
history
Dr Will Teh
Chair, LCA Breast Pathway Group
Familial Breast Cancer Steering
Group Meeting
Thursday 11 December 2014
14.30 – 16.30pm
Southside
Chair: Will Teh
NICE Guidance : Risk Category
NICE Defined Breast Cancer Risk Category
Near Population
Risk
Lifetime risk from Less than 17%
age 20
Moderate Risk
High Risk*
Greater than 17% 30% or greater
but less than 30%
Risk between
ages 40 and 50
Less than 3%
3-8%
Commissioning
Responsibility
Primary Care
CCGs
Greater than 8%
Screening
Specialist – for
Genetics Services
only
*This group includes known BRCA1, BRCA2, TP53 mutations, and rare
conditions that carry an increased risk of breast cancer.
NICE Guidance: Moderate Risk Service Offer
• Family history risk assessment
• Surveillance
– offer annual mammography 40 – 49 years
– ‘consider’ annual mammography 50 – 59 years
• Chemoprevention – ‘consider’ for moderate
risk group. Tamoxifen or raloxifene
NICE Estimated Additional Annual Costs for London
• Annual mammographic surveillance (CCGs)
– 40-60 year olds: £1,438,000 pa
– £95 per screen (including call, recall and failsafe)
– Additional cost per CCG ranges from £68k to £27k
• Chemo prevention (CCGs)
– £72,000 across London, <£3,100 per CCG
• Genetics Services (Specialist Commissioning)
– £332,000 across London
2015-16 Commissioning Intentions: Breast
Screening
•
Reconfiguration of breast screening services across London to create a Londonwide model that allows for:
–
–
–
–
–
Flexible access to different sites
Centralised administration function
Improvement in uptake
Improved quality of service
Structured tariff setting etc
•
Work with CCGs to agree commissioning responsibility for women with moderate
risk breast screening as part of the potential new model of service
•
Review the 62 day cancer waits (screening pathways) to ensure these are robust
and fit for purpose
•
Ensure the full implementation of age extension screening across London in
2015/16
Engagement and
consultation
Expressions of
interest
Pre-Qualification
Questionnaire
Invitation to
Tender
Contract award
Implementation
Start date
April
March
February
January
December
November
October
September
August
July
June
May
April
March
February
January
December
November
Breast Screening Reconfiguration
Procurement timetable
Future Commissioning of Genetics Testing
Recommendation 4 from ‘Genetics and Mainstream
Medicine: Service Development and Integration’
• There should be a review of genetic test provision to respond effectively
and efficiently to increasing demand, rapidly developing capabilities and
changing technologies
• This should be undertaken in the context of national pathology
modernisation and should include how:
– laboratories can best respond to increased demand for testing
– to maintain quality in NHS services, appropriate gate-keeping and the development of
mechanisms for requesting, funding and providing genetic tests
– genetic tests should be evaluated and regulated
Baseline Mapping of Current Service
Provision by ICS’s
•
•
•
•
•
•
•
Source of referral
Family history risk assessment
Mammographic surveillance
Call, recall and failsafe systems
Data bases
Workforce issues
Support for Primary care
Proposed Workstreams
• Patient Pathways and Clinical Protocol
development (including guidance for primary
care)
• Call, recall and failsafe systems
• Database development
• Develop service specification
• Financial modelling
Break
Minimising 62 screening
breaches
Dr Will Teh
Chair, LCA Breast Pathway Group
Screening ‘performance/waiting
times’ standards
• Screen-results 2 weeks
• Screen-assessment 3 weeks
• Assessment to results 1 week
Screening- ‘Cancer Waiting Times’
standards
• 62 days standard: Referral - first treatment
• 31 days standard: Decision to treat – First treatment
• 62 days referral date is NOT date of referral by screening unitbreast unit BUT date when decision is made by screening unit
to recall patient for further assessment
• Referral date = date of recall at screening unit
(usually after double reading or consensus/arbtration reading)
Screen to Last Read Cancers
(Source London ABS at BASO 2013-14 Audit)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
ECX
EBA
FLO
5 days or less
HWA
Over 5 up to 10 days
FBH
over 10 days
GCA
London
Screen to Actual Assessment Cancers
(Source London ABS at BASO 2013-14 Audit)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
ECX
EBA
FLO
up to 3 weeks
HWA
over 3 weeks up to 4 weeks
FBH
over 4 weeks
GCA
London
62 day ‘breach’
Last Read to First Surgery-BASO Cancers with Surgery
(Excluding those with Neo Adjuvant recorded)
Source London ABS at BASO Cancers 2013-14 Audit
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
ECX
EBA
FLO
HWA
Within 62 days
FBH
Outside
GCA
London
Breast Screening 62-Day Audits
• West of London (ECX) – Gareth Gwynn, Imperial
• South West London (HWA) – Louise Wilkinson, St
George’s
• North London (EBA) – Claire Mabena, Royal Free
NWL Provider Cancer Pathways
11th December
139
Breast Pathway
Keys issues:
• Imaging capacity
• Increased referrals/demand [37 % increase in Ca
diagnoses from 2010 to 2014]
• Variable Diagnostic protocols (Multiple further
investigations at some Trusts)
• Small numbers for Screening Pathway per provider [0.5
breach is enough to fail the target]
• Late repatriation from Screening Centre
140
Breast Pathway
Key solutions:
• Review of imaging capacity/demand/resource
• Agree diagnostic protocol
• Allocated New Patient appointment slots for
screening referrals
• Review of Screening Centre repatriation pathway
Improving outcomes considerations:
• 23 hour breast mastectomy
• Access to immediate reconstruction surgery
141
Breast Screening Audit Data
Number
Number
Number
Month
Recalled to
Screened
of Cancers
Assessment
April 2013
3642
164
21
May
4015
213
43
June
3673
164
23
July
4561
224
44
August
3624
148
32
September
4100
205
28
October
4056
185
30
November
3881
181
39
December
1223
60
6
January 2014
2879
171
26
February
3463
200
28
March
3858
227
38
Breast Screening Audit Data
Site of first treatment for diagnosed cancers
Trust
CXH
Hillingdon
West Middlesex
Ealing
Royal Marsden
Northwick Park
Princess Grace
Princess Margaret
Cromwell
Clem Church
Harley St
Guys
UCLH
Royal Free
Bishops Wood
London Clinic
Ashford
Whittington
Abroad
Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14
10
3
3
1
2
1
1
-
29
8
1
3
1
1
-
17
1
2
2
1
-
29
8
1
3
1
1
1
-
13
6
4
1
1
2
1
1
1
2
-
13
9
3
2
1
-
15
9
2
1
1
2
-
24
3
2
1
1
1
1
2
1
1
1
1
5
1
-
15
2
4
2
3
-
13
4
4
1
3
1
1
1
-
15
7
3
3
4
1
1
1
1
1
1
Total
198
59
25
18
18
4
9
1
3
2
6
2
3
2
1
1
3
1
2
Breast Screening Audit Data
Point of repatriation for
62 day breaches
Trust
ICHT
WMUH
Ealing
NWL
GSTT
UCLH
62-day
breaches
6
10
3
3
1
1
Repatriation
by day 31
3
5
2
1
0
0
Repatriation
day 32-42
0
3
0
1
1
0
Screening performance
by site
Trust
ICHT
WMUH
Ealing
NWL
GSTT
UCLH
62-day
Breaches
6
10
3
3
1
1
Total
Treatments
198
25
18
4
2
3
CWT
Performance
97.0%
60.0%
83.3%
25.0%
50.0%
66.7%
Repatriation
day 42-62
0
1
0
0
0
1
Repatriation
after day 62
3
1
1
1
0
0
Auditing 62 day pathway in
Screening
Dr Louise Wilkinson
South West London Breast Screening
Service
62 day pathway for screen
detected cancer
• Describe the pathway
• Present data from 2 screening services
• Outcome of today
– Flagging cancers as screen detected
– Why is referral delayed
– Optimise referral processes
– Establish systematic audit
Pathway
Communication + time to
re-arrange appointment
Last read
Second read or
arbitration
Assessment
May need repeat /
additional tests
Results to client
Client may need
more time
Optimal referral process
Referral to treating hospital
Outpatient Appointment
Capacity for short
notice OPA
Treatment
Capacity for
surgery
Optimal and Minimum Standard
From
To
Target Minimum
(days) standard
(days)
Total from
last read
(days)
Last read
Assessment
10
21
10
(18)
Assessment
10
15
(31)
2
16
(33)
Referral
Result to client
5
(inc MDM)
Referral received 1
by surgical team
Surgical OPA
7
10
23
(43)
Surgical OPA
Treatment
31
47
(74)
Results to client
14
Target waiting times
31 days
62 days
Assessment
Results
Referral
OPA
surgery
0
10
20
30
40
50
60
70
80
90
100
Minimum standard waiting times
31 days
62 days
Assessment
Results
Referral
OPA
surgery
0
10
20
30
40
50
60
70
80
90
100
250
200
1
9
17
25
33
41
49
57
65
73
81
89
97
105
113
121
129
137
145
153
161
169
177
185
193
201
209
217
225
233
241
249
257
265
273
281
289
297
305
313
321
329
337
345
353
361
369
377
SWLBSS 2013-14
383 Cancers, 298 flagged as screening
Days to treatment
400
350
300
62 days
150
100
50
0
Pathway analysis -1 treatment centre
- referred 01/01 to 30/06/2014
31 days
62 days
Assessment
Results
Referral
OPA
Treatment
0
10
20
30
40
50
60
70
80
90
100
Breach analysis
Number Number
Comments
referred
after 31 days
<63 days
33
1
1 x Client delayed assessment
63 – 65 days 4
1
1 x mastectomy
1 x mastectomy + immediate reconstruction)
2x?
66-90 days
7
1
1 x B3 excision, coincidental small cancer
3 x mastectomy (inc 1xbilateral risk reducing)
2 x client holiday
1x surgical capacity
>90 days
3
3
1 x B3, VACE – dcis + 4mm ILC, needed MRI
2 x delayed assessment
Total
47
6
Data reviewed (3 x patient ID)
1.
2.
3.
4.
5.
6.
7.
8.
NBSS client screening record
NBSS BASO data
NBSS assessment activity analysis
Paper record of ‘result to client date’
SGH PACS
SGH EPR
SGH 62 day cancer waits
NHSE (London) 62 day waits
Screen detected
NBSS* v Open Exeter
Screening Cancers
on NBSS (episode)
2013/14
Screening Cancers on
Open Exeter (treatment)
01/9/2013 – 31/08/2014
Percentage of
NBSS/Open Exeter
- very approximate
NELBSS 508
290
(excluding West Herts)
57%
WoLBSS 358
314
88%
BHRBSS 215
157
(excluding Brentwood)
73%
CELBSS
193
186
96%
SELBSS
356
382
107%
SWLBSS 383
336
88%
* Excludes high risk?
Issues
1. Documenting screening origin (LCA metric)
2. Delays to pathway
– Patient choice
– Complex diagnostics (B3 lesions)
3. Optimise referral process
– Documentation
– Allocated clinic spaces
4. Establish routine audit
Optimising patient pathways and
repatriation - NLBSS (Royal Free)
experience
Clare Mabena
Lead CNS Breast Screening, NLBSS, Royal
Free London NHS Foundation Trust.
Lead CNS Breast London Cancer.
Screening summary
2013-2014
Number Invited
87025
Number Screened
61085
Number assessed
3464
Number of cancers diagnosed
508
Number of 62 day breaches
15 (3%)
National Target - 90% of women referred from NHS Cancer Screening
Programme to first treatment should be within 62 days.
Potters Bar
Abbots
Langley
Watford
Sainsburys
Barnet
Hospital
Borehamwood
St
Michaels
Ann’s
Oxhey
Finchley
Memorial
Forest
Primary
Care Centre
NLBSS
St Ann’s
Northwick
Park Hospital
Wembley
Centre for
Health and Care
Central
Middlesex
508 women referred
Women referred to hospitals by
screening site
62 day breaches by hospital
15 Breaches
Breach Analysis
Trust
62 day
breaches
Barnet and Chase
5
Farm
Repatriation Repatriation Repatriation repatriation 62 day breach reason
by day 31
by day 32-42 by day 42-62 after day 62
1
0
3
1
3x patient choice
1x repeat biopsy
1x repeat imaging needed
Northwick Park
3
3
0
0
0
Royal Marsden
4
0
1
3
0
St Albans
1
0
1
0
0
1x patient choice
Whittington
2
1
0
0
1
1x patient choice and repeat biopsy
1x unknown
Trust
Barnet and Chase Farm
Northwick Park
Royal Marsden
St Albans
Whittington
2x patient choice
1x repeat biopsy
3x patient choice and repeat biopsy
1x repeat biopsy
62 day breaches
Total
referrals
62 day
performance
5
3
155
96.80%
100
97%
4
18
77.80%
1
34
97.10%
2
23
91.30%
Current good practice at NLBSS
• NLBSS Information Officer sends monthly data to Senior
Information Analyst, Royal Free London, of women referred
from screening
• 62 day alert form for each patient referred for assessment
• Post biopsy – identify day 0 – 62 in MDT book
• Discuss day 0 – 62 in MDT
• Post MDT – complete 62 day proforma and send to hospital
referred to, including breach date and explanation of 31 day
breach
• 6-monthly meetings with Cancer Waiting Time Manager at
the Royal Free
Good Practice for the future
• Quarterly meetings with a Cancer Waiting
Time Manager
• Establish links with all Cancer Waiting Time
Managers for all external organisations
• 6-monthly updates from external units on
screening referrals
Discussion
Summary and Close