Clinical

National Oesophago-Gastric Cancer Audit: Progress Update

Thursday, 20 December 2012 10:00

Annual Report

This year's annual report was published in July 2012 (https://catalogue.ic.nhs.uk/publications/clinical/oesophago-gastric/nati-clin-audi-supp-prog-oeso-gast-canc-2012/clin-audi-supp-prog-oeso-gast-2012-rep.pdf) and focused on the results of the organisational survey, and provided longer-term follow up and analysis of data collected during the first audit cycle.

The key findings were:

  • Reorganisation of cancer services has been completed and patients have good access to key diagnostic services and therapeutic procedures.
  • There was substantial variation in route to diagnosis, with overall 16.4% of patients were being diagnosed after an emergency admission. This group has a lower chance of proceeding to curative treatment, so early diagnosis and detection is still a key issue.
  • 3 year survival rates after curative therapy have improved, with rates of 41% for oesophageal squamous cancers, 46% for oesophageal adenocarcinomas and 49% for gastric cancers. This is compared to 34% for oesophageal cancer, and 40% for gastric cancer treated in the 1990’s with curative intent.

Initial results from 2nd Audit

This focuses on patients diagnosed between 1st April 2011 and 31st March 2012. Initial results appear encouraging, with preliminary analysis suggesting:

  • Overall case ascertainment of 80% (10% higher than previous audit).
  • Clinical information was collected from 10,604 patients.
  • 3291 patients treated with curative intent.
  • In-hospital mortality rates are continuing to fall.

Full analysis of these results will be published in June 2013 in the second Annual Report. Data will be provided at NHS trust level to allow national benchmarking and identify areas for potential improvement.

What is new?

New Dataset: For patients diagnosed since April 2012 the dataset has been revised, with the aim of being more focused and also allowing collection of data on patients with HGD. The new dataset has decreased the number of data items required, but more key variables are now mandatory. These changes follow requests from the last audit and we hope therefore will provide NHS trusts with more useful information.

To submit this data NHS trusts will need to re-register for the new data collection system, to comply with information governance requirements. Note that updating the dataset will mean CSV files will need to be adjusted as both the structure and data item have changed.

High Grade Dysplasia (HGD): From 1st April 2012, data on patients diagnosed with Barrett's HGD of the oesophagus is being collected. Little is known about the care of this patient group. It is estimated that there are 1350 new cases per year in England and Wales and it is recommended that all these patients are discussed in the specialist MDT. The new dataset aims to evaluate the management of patients, their treatment and early outcomes.

Online reporting system: This is currently being revised with aim of providing clinicians with up to date clinically relevant information. Units will be able to download their data from the Audit’s IT system into Excel sheets. This will allow it to be used for local quality improvement and to support peer review.

The Future

Overall, the case ascertainment and quality of data continues to improve and this would not be possible without the huge amount of work everyone is putting in, from clinicians, to data managers and MDT co-ordinators across the country.

Finally, we would like to make a special plea to for you to engage with your pathology and surgical colleagues to ensure you have robust systems to facilitate MDT review of all patients with Barrett's HGD. As incidence of Barrett's HGD is relatively low, high case ascertainment is crucial to make the results valid for this patient group.

The Audit will continue to be led clinically by Richard Hardwick, Stuart Riley and Tom Crosby. Methodological aspects are supervised by David Cromwell and Oliver Groene at the RCS Clinical Effectiveness Unit (CEU). We have now recruited a new Clinical Fellow Georgina Chadwick (a Gastroenterology SpR), who will be working on the project based at the CEU. Kimberly Greenaway continues as the Project Manager.

If you have any further questions, do get in contact with one of us and thank you again for all your hard work.


Kind regards,

Stuart Riley

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