Brain and CNS Cancer. Measurability of Quality Performance Indicators Version 3.0

Transcription

1 Brain and CNS Cancer Measurability of Quality Permance Indicators Version 3.0 To be read in conjunction with: Brain and Central Nervous System Cancer Clinical Quality Permance Indicators Brain and Central Nervous System Cancer Data Definitions (latest published version) Brain/CNS Cancer QPI Measurability v3.0 1

2 Measurability of Quality Permance Indicators Brain & CNS Cancer Please refer to the Brain and CNS Cancer Quality Permance Indicators published by Healthcare Improvement Scotland a full description of individual QPIs Please refer to the Brain and CNS Cancer QPI Dataset published by ISD Scotland a full description of individual data items Document control: This version Title Brain & CNS Cancer Measurability of QPIs Version/Issue Number 3.0 Effective From January 2017 Author Jane Garrett, ISD Document Type Guidance Document status Final Document Purpose Publication Summary of changes Final V3.0 DATE Final In addition to reporting by Hospital of Diagnosis, the following QPIs should also be reported by Board of Surgery: 3 (a/b), 6, 7, 13 (surgery only) Revision History Version Date Status Summary of Changes QPI (s) 0.1 June 2013 Draft First version All 0.2 Dec 2013 Draft Changes following public engagement 1.2 June 2014 Final Amendments made out-with review, incorporating additional data item into the dataset updating the MDT 2 QPI. 2.0 Nov 2014 Final Change to version number due to changes in dataset n/a 2.1 May 2015 Final Amendments made out-with review 1, 2, August 2015 Final Amendments made out-with review 6,9 2.3 March 2016 Final Amendments made following Baseline Review 3,5,6,7,8,9, April 2018 Final Amendments following Formal Review. NB: Formal Review measurability changes apply to patients diagnosed in year 4 data collection (01/01/ /12/2017) with the exception of measures which require new data items. These changes will apply to patients diagnosed in year 5 data collection (01/01/ /12/2018). This will apply to the QPI s listed: Brain/CNS Cancer QPI Measurability v3.0 2 Year 4: 1, 8, 13 Year 5: 2, 3, 4, 5, 6, 7, 9, 10, 11, 12 Updates from Previous Version QPI Summary of changes (excluding matting changes) (April 2018) 2 QPI Title: change definitive management to any surgical procedure* ; Desc: change definitive management to surgery ; Num: change definitive management to surgery ; change Date of Definitive Treatment OR Date of Definitive Treatment is equal to not applicable. to Date of First Surgical Procedure ; change DEFTREATDATE] OR [DEFTREATDATE = 10/10/1010]) to DFIRSTSURG ; Den: add undergoing surgery, AND Date of First Surgical Procedure not coded as inapplicable, [DFIRSTSURG <> 10/10/1010] AND; NRnum delete [DEFTREATDATE = 09/09/0909] ; NRden add OR [DFIRSTSURG = 09/09/0909] ; Add Note *Please note that surgical procedures include diagnostic biopsies.

3 3 Desc: change analysis to analysis a ; Num(i) add Grade II or III ; change with an oligodendroglial 1 component to undergoing surgery ; Den(i) add Grade II or III ; delete with an oligodendrogliala component ; delete Mixed, NOS; Oligodendroglioma, anaplastic ; delete or Grade IV ; add 9400/3 OR 9411/3 OR 9401/3 OR 9440/3 OR 9441/3 OR 9442/3 OR 9445/3 OR 9385/3 OR 9425/3 OR 9431/3 OR 9430/3 OR ; delete 9382/3 OR and OR 4 ; Num(ii) add undergoing surgery ; Note: delete This includes -oligodendroglioma (WHO Grade II) - anaplastic oligodendroglioma (WHO Grade III) - oligoastrocytomas (WHO Grade II)- anaplastic oligoastrocytoma (WHO Grade III) - glioblastoma with an oligodendroglial component (WHO Grade IV) ; add WHO classification of CNS tumours (2016) uses molecular parameters in addition to histology to define tumour entities. In addition to those outlined in the QPI, relevant molecular analysis also include those outlined in 2016 World Health Organisation Classification of Tumours of the Central Nervous System. 4 QPI Title: add tumour type as described in World Health Organisation (WHO) Classification of CNS tumours (2016) and WHO grade where appropriate) ; Desc: delete diagnosed ; add brackets to as defined by the Royal College of Pathologists ; Num: add brackets to as defined by the Royal College of Pathologists 5 QPI Title: add contrast enhanced ; Desc: change resection and/or radical radiotherapy or chemotherapy to surgery ; add contrast enhanced ; Num: change resection of tumour, radical radiotherapy or chemotherapy to surgery ; add contrast enhanced ; add AND Date MRI Scan (Pre-treatment) is bee or equal to Date of First Surgical Procedure and add AND [MRIDATE DFIRSTSURG] ; Den: change resection of tumour, radical radiotherapy or chemotherapy to surgery ; add contrast enhanced ; delete Cerebral aneurysm clip; Metal in eye; and delete Unable to fit bore of scanner; Too heavy MRI table) ; add Date of First Surgical Procedure not coded as inapplicable ; delete (Main Type of Definitive Surgery{Brain/CNS Cancer} 1-4 coded as Craniotomy lesion of frontal lobe, Craniotomy lesion of temporal lobe, Craniotomy lesion of parietal lobe, Craniotomy lesion of occipital lobe, Craniotomy lesion of cerebellum, Craniotomy lesion of brain tissue - other site, or Craniotomy lesion of cerebellum; OR Radiotherapy Course Type {Brain/CNS Cancer} 1-2 coded as Radical, or Chemoradiotherapy; OR Type of Systemic Anti- Cancer Therapy (SACT) (Brain/CNS Cancer) 1-2 coded as Neoadjuvant, or Chemoradiotherapy; ; add [DFIRSTSURG <> 10/10/1010] ; delete ( [OPCODE1 OR OPCODE2 OR OPCODE3 OR OPCODE4 = A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.8 OR A02.5] OR [RADIO1 OR RADIO2 = 3 OR 7] OR [CHEMTYPE1 OR CHEMTYPE2 = 02 OR 05] ); NRNum: add OR [MRIDATE] ; NR Den: add [DFIRSTSURG = 09/09/0909] delete [OPCODE1 OR OPCODE2 OR OPCODE3 OR OPCODE4 = 99] OR [RADIO1 OR RADIO2 = 99] OR [CHEMTYPE1 OR CHEMTYPE2 = 99] 6 Desc: change maximal surgical resection (>90% resection of the measurable enhancing component) to surgical resection where 90% reduction in tumour volume is achieved ; Num: change >90% to 90% ; delete 99% or ; change 3 OR 4 to 5 ; Den: add and Patients in whom surgeons intent is partial resection / debulking surgery) ; delete NOS ; add Anaplastic astrocytoma, Gliosarcoma, Oligoastrocytoma, Anaplastic, Oligoastrocytoma, Anaplastic pleomorphic xanthoastrocytoma, Anaplastic ependymoma ; change AND Post Surgical MRI coded as Yes to AND Intent of Surgery not coded as partial resection / debulking surgery ; delete 9382/3 ; add 9401/3 OR 9445/3 OR 9424/3 OR 9392/3 ; change [POSTMRI = 1] to [OPINTENT <> 2] ; Note: delete Mixed tumours e.g. oligoastrocytoma, glioblastoma with oligodenroglial component ; add Anaplastic pleomorphic xanthoastrocytoma ; add Anaplastic ; Spec(ii): delete Num(ii); delete Den(ii); NRExcl: change N/A to [OPINTENT = 99] ; NRDen(i): delete [POSTMRI = 99] ; delete NRDen(ii) 7 Num: change receiving MRI to who receive MRI ; Den: delete Metal in eye; Claustrophobia;Unable to fit bore of scanner; Too heavy MRI table); delete NOS ; add Anaplastic astrocytoma, Gliosarcoma, Oligoastrocytoma; Anaplastic Oligoastrocytoma; Anaplastic pleomorphic xanthoastrocytoma; Anaplastic ependymoma ; delete 9382/3 ; add 9401/3 OR 9445/3 OR 9424/3 OR 9392/3 ; Note: delete Mixed tumours e.g. oligoastrocytoma, glioblastoma with oligodenroglial component ; add Anaplastic pleomorphic xanthoastrocytoma ; add Anaplastic 9 Den: delete NOS ; add Anaplastic astrocytoma, Gliosarcoma, Oligoastrocytoma; Anaplastic Oligoastrocytoma; Anaplastic pleomorphic xanthoastrocytoma; Anaplastic ependymoma ; delete 9382/3 ; add 9401/3 OR 9445/3 OR 9424/3 OR 9392/3 ; 10 QPI Title: change primary brain/cns cancer to brain/central Nervous System (CNS) cancer ; Desc: change primary brain/central nervous system (CNS) to brain/cns ; Den: delete primary and Metal in eye; Claustrophobia; Unable to fit bore of scanner; Too heavy MRI table ; Note: add 1 Radical is defined as radiotherapy courses where 15 fractions are delivered. 11 QPI Title: change a nurse with expertise in epilepsy management to named epilepsy specialist nurse (ESN) ; Desc: change nurse with expertise in epilepsy management to named ESN within four weeks of diagnosis ; Num: change nurse with expertise in epilepsy management to named ESN within four weeks of diagnosis ; change Nurse with expertise in epilepsy management to Named Epilepsy Specialist Nurse (ESN) ; change nurse with expertise in epilepsy management to Named Epilepsy Specialist Nurse ; add AND Date seen by Neurologist and/or Named Epilepsy Specialist Nurse minus Date of Diagnosis less than or equal to 28 days ; add AND [EPILNESNDATE DIAGDATE 28] ; NRNum: add OR [EPILNESNDATE = 09/09/0909] 12 Inserted New QPI - Key Worker 13 Inserted New QPI - 30 Day Mortality after Treatment Brain/CNS Cancer QPI Summary of changes (excluding matting changes) (March 2016) Brain/CNS Cancer QPI Measurability v3.0 3

4 3 Description, Numerator & Denominator changed reference numbers to letters and inserted reference text to align with the QPI document - a This includes: - oligodendroglioma (WHO Grade II) - anaplastic oligodendroglioma (WHO Grade III) - oligoastrocytomas (WHO Grade II) - anaplastic oligoastrocytoma (WHO Grade III) - glioblastoma with an oligodendroglial component (WHO Grade IV) b including subtypes (WHO Grade IV) c The O(6)-methylguanine-DNA methyltransferase (MGMT) gene 5 Denominator removed and Patients undergoing biopsy only ; Main type of Definitive Operation changed to Main Type of Definitive Surgery ; deleted SCAN from MRI SCAN changed equation from [SCAN <> (95 OR...)] to [MRI <> (95 OR...)] 6 Deleted high grade (world health organisation (WHO) Grades III and IV) from QPI title and inserted d after malignant gliomas. Description deleted high grade and after malignant glioma inserted d (with enhancing component on pre-operative imaging) also after 90% inserted resection of the measurable enhancing component Numerator and Denominator have now been split into 2 specifications. Numerator (i) is Number of patients with resectable malignant gliomad (with enhancing component on pre-operative imaging) undergoing surgical resection where >90%* reduction in tumour volume is achieved. Denominator (i) is All patients with malignant gliomad (with enhancing component on pre-operative imaging) undergoing surgical resection. (Excluding patients undergoing biopsy only 1 ). Date of Diagnosis [DIAGDATE] in range specified comparative analysis; AND Morphology of Tumour coded as Glioblastoma, NOS; Giant cell glioblastoma, Oligodendroglioma, NOS; Oligodendroglioma, anaplastic; AND Main Type of Definitive Surgery {Brain/CNS Cancer} coded as Craniotomy lesion of frontal lobe, Craniotomy lesion of temporal lobe, Craniotomy lesion of parietal lobe, Craniotomy lesion of occipital lobe, Craniotomy lesion of cerebellum, Craniotomy lesion of brain tissue - other site AND Enhancing component present on pre-operative imaging coded as yes AND Post Surgical MRI coded as Yes - [MORPHOL = 9440/3 OR 9441/3 OR 9442/3 OR 9382/3 OR 9450/3 OR 9451/3] AND [OPCODE1 OR OPCODE2 OR OPCODE3 OR OPCODE4 = A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8] AND [ENHANC = 1] AND [POSTMRI = 1]. Numerator (ii) is Number of patients with resectable malignant glioma d (with enhancing component on pre-operative imaging) undergoing surgery (biopsy and surgical resection) where >90%* reduction in tumour volume is achieved. - Reduction in Tumour Volume {Brain/CNS Cancer} coded as 90-99% or 100% - [REDUCT = 3 OR 4]. Denominator (ii) is All patients with malignant glioma d (with enhancing component on pre-operative imaging) undergoing surgery (biopsy and surgical resection) (No exclusions).- Date of Diagnosis [DIAGDATE] in range specified comparative analysis; AND Morphology of Tumour coded as Glioblastoma, NOS; Giant cell glioblastoma, Oligodendroglioma, NOS; Oligodendroglioma, anaplastic; AND Main Type of Definitive Surgery {Brain/CNS Cancer} coded as Craniotomy lesion of frontal lobe, Craniotomy lesion of temporal lobe, Craniotomy lesion of parietal lobe, Craniotomy lesion of occipital lobe, Craniotomy lesion of cerebellum, Craniotomy lesion of brain tissue - other site, Biopsy only AND Enhancing component present on pre-operative imaging coded as yes AND Post Surgical MRI coded as Yes - [MORPHOL = 9440/3 OR 9441/3 OR 9442/3 OR 9382/3 OR 9450/3 OR 9451/3] AND [OPCODE1 OR OPCODE2 OR OPCODE3 OR OPCODE4 = A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8 OR 98] AND [ENHANC = 1] AND [POSTMRI = 1]. NR Exclusion replaced [OPCODE1 OR OPCODE2 OR OPCODE3 OR OPCODE4 =99] with N/A; NR Denominator changed to 2 specs (i) [MORPHOL = 9999/9] OR [OPCODE1 = 99 AND OPCODE2-4 <> (A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8) OR OPCODE2 = 99 AND OPCODE1, 3, 4 <> (A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8) OR OPCODE3 = 99 AND OPCODE 1, 2, 4 <> (A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8) OR OPCODE4 = 99 AND OPCODE1-3 <> (A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8)] OR [ENHANC = 99] OR [POSTMRI = 99] and (ii) [MORPHOL = 9999/9] OR [OPCODE1 = 99 AND OPCODE2-4 <> (A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8 OR 98) OR OPCODE2 = 99 AND OPCODE1, 3, 4 <> (A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8 OR 98) OR OPCODE3 = 99 AND OPCODE 1, 2, 4 <> (A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8 OR 98) OR OPCODE4 = 99 AND OPCODE1-3 <> (A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8 OR 98)] OR [ENHANC = 99] OR [POSTMRI = 99] References have now changed from Malignant gliomas include: Grade IV (Glioblastoma multime- GBM and its variants e.g. gliosarcoma), Grade III (Anaplastic Astrocytoma- AA), Grade III anaplastic oligodendrogliomas, Grade III or IV mixed tumours e.g. oligoastrocytoma, glioblastoma with oligodenroglial component, Highgrade ependymoma To d Malignant gliomas include: Glioblastoma multime- GBM and its variants e.g. gliosarcoma, Anaplastic Astrocytoma- AA, Anaplastic oligodendrogliomas, Mixed tumours e.g.oligoastrocytoma, glioblastoma with oligodenroglial component, High-grade ependymoma e Patients undergoing biopsy only are excluded by default due to the operation codes used within this measurability * Percentage tumour reduction should be assessed by comparing pre surgical imaging to post surgical 72hr Magnetic Resonance Imaging (MRI) 7 QPI title, Description and Numerator inserted d after malignant glioma, removed (WHO Grades II, III and IV) and inserted (with enhancing component on pre-operative imaging); Denominator inserted d after malignant glioma, removed (WHO Grades II, III and IV) and inserted (with enhancing component on pre-operative imaging), deleted AND WHO Grade coded as Grade II, Grade III or Grade IV, Main type of Definitive Operation changed to Main Type of Definitive Surgery, removed or Craniotomy lesion of cerebellum, inserted Enhancing component present on pre-operative imaging coded as yes; AND, removed Not applicable patients undergoing biopsy only, removed AND [GRADE = 2 OR 3 OR 4], OPCODE OR A02.5, POSTMRI OR 96 inserted AND [ENHANC =1]; NR Denominator removed OR [GRADE = 99] and inserted OR [ENHANC = 99] Reference d Malignant gliomas include: Glioblastoma multime- GBM and its variants e.g. gliosarcoma, Anaplastic Astrocytoma- AA, Anaplastic oligodendrogliomas, Mixed tumours e.g.oligoastrocytoma, glioblastoma with oligodenroglial component, High-grade ependymoma is now inserted. 8 Denominator removed radiotherapy course type coded as Adjuvant, Neo adjuvant 1 OR 2 OR 9 Changed from Access to Adjuvant Treatment to Access to Oncological Treatment ; QPI Title removed surgical resection and inserted surgery ; Description changed surgical resection to surgery throughout and receive to commence ; Numerator changed from Number of patients with high grade glioma (WHO grades III and IV) Brain/CNS Cancer QPI Measurability v3.0 4

5 who undergo surgical resection who commence oncological treatment (chemotherapy, radiotherapy or chemoradiotherapy) within 6 weeks of surgical resection. - Radiotherapy Course Type {Brain/CNS Cancer} 1; or Type of Systemic Anti-Cancer Therapy (SACT) {Brain/CNS Cancer} 1 coded as adjuvant or chemoradiotherapy; AND Date Treatment Started {Cancer} (Radiotherapy) 1; or Date Treatment Started Systemic Anti-Cancer Therapy (SACT) 1 minus Date of Definitive Surgery is less than or equal to 42 - ( [RADIO1 = 1 OR 7] AND [RADDATE1 DSURG 42] ) OR ( [CHEMTYPE1 = 1 OR 5] AND [CHEMDATE1 DSURG 42] ) To Number of patients with high grade glioma (WHO grades III and IV) who undergo oncological treatment (chemotherapy, radiotherapy or chemoradiotherapy) who commence treatment within 6 weeks of surgery. - Date Treatment Started {Cancer} (Radiotherapy) 1; or Date Treatment Started Systemic Anti-Cancer Therapy (SACT) 1 minus Date of Definitive Surgery is less than or equal to 42 - [RADDATE1 DSURG 42] OR [CHEMDATE1 DSURG 42] ) ; Denominator changed from All patients with high grade glioma (WHO grades 3 and 4) who undergo surgical resection. (No exclusions) - Date of Diagnosis [DIAGDATE] in range specified comparative analysis; AND Morphology of Tumour coded as Glioblastoma, NOS; Giant cell glioblastoma, Oligodendroglioma, NOS; Oligodendroglioma, anaplastic; AND WHO Grade coded as Grade III or Grade IV; AND Main Type of Definitive Surgery {Brain/CNS Cancer} 1-4 coded as Craniotomy lesion of; frontal lobe, temporal lobe, parietal lobe, occipital lobe, cerebellum or brain tissue other site. - [MORPHOL = 9382/3 OR 9440/3 OR 9441/3 OR 9442/3 OR 9450/3 OR 9451/3] AND [GRADE = 3 OR 4] AND ([OPCODE1 OR OPCODE2 OR OPCODE3 OR OPCODE4 = A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8]) ; NR Numerator equation changed from [RADDATE1 = 09/09/0909] OR [CHEMDATE1 = 09/09/0909] OR [DSURG = 09/09/0909] OR [RADIO1 = 99] OR [CHEMTYPE1 = 99] To ([RADDATE1 = 09/09/0909] AND [CHEMDATE1 = 09/09/0909]) OR [DSURG = 09/09/0909] ; NR Denominator equation changed from [MORPHOL = 9999/9] OR [GRADE = 99] OR [OPCODE1 OR OPCODE2 OR OPCODE3 OR OPCODE4 = 99] To [MORPHOL = 9999/9] OR [GRADE = 99] OR [OPCODE1 = 99 AND OPCODE2-4 <> (A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8 OR 98) OR OPCODE2 = 99 AND OPCODE1, 3, 4 <> (A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8 OR 98) OR OPCODE3 = 99 AND OPCODE 1, 2, 4 <> (A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8 OR 98) OR OPCODE4 = 99 AND OPCODE1-3 <> (A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8 OR 98)] OR [(RADIO1 = 99 AND CHEMTYPE1 <>(1 OR 5)] OR [(CHEMTYPE1 = 99 AND RADIO1 <> (3 OR 7)] 10 Denominator added Chemoradiotherapy Radiotherapy Course Type [RADIO1 OR RADIO2 = 3 OR 7] QPI Summary of changes (excluding matting changes) (August 2015) 6 Remove duplicate 'or Craniotomy lesion of cerebellum' and duplicate opcode 'OR A NR Denominator MORPHOL = 9999/9 instead of 99 and OPCODE = 99 instead of 9999/9. QPI Summary of changes (excluding matting changes) (May 2015) 1 NR Num changed to [PSTATUS <>9] AND ([WHODATE = 09/09/0909] OR [MDTDATE = 09/09/0909]), NR Den changed to [ICDSITE = C99.X] OR [MDTDATE = 09/09/0909] 2 Numerator changed to [MDTDATE <> 10/10/1010] AND ([MDTDATE DEFTREATDATE] OR [DEFTREATDATE = 10/10/1010]) 9 RADIO2 and CHEMTYPE2 removed, chemoradiotherapy added QPI Summary of changes (excluding matting changes) (June 2014) 2 Inserted new MDT QPI. 8 Numerator amended Specialist Neuro-oncologist {Brain/CNS Cancer} coded as Yes [SPECNEURO = 01], NR Numerator amended [SPECNEURO = 99] Brain/CNS Cancer QPI Measurability v3.0 5

6 QPI 1 - Documentation of Permance Status QPI Title: Numerator: Patients with newly-diagnosed brain/central nervous system (CNS) cancer should have a world health organisation (WHO) permance status documented at time of diagnosis. Proportion of newly-diagnosed patients with brain/cns cancer who have a documented WHO permance status at the time of multidisciplinary team (MDT) discussion. Number of newly-diagnosed patients with brain/cns cancer discussed at MDT meeting with a documented WHO permance status at the time of MDT discussion. WHO/ECOG Permance Status not coded as Not Applicable; AND Date of Assessment of WHO/ECOG Permance Status (KPS) is less than or equal to Date Discussed by Care Team (MDT) [PSTATUS <> 9] AND [WHODATE MDTDATE] Denominator: All newly-diagnosed patients with brain/cns cancer discussed at MDT meeting (No exclusions). Date of Diagnosis [DIAGDATE] in range specified comparative analysis; AND Site of Origin of Primary Tumour {Brain/CNS Cancer} 1-4 coded as Brain/CNS Cancer; AND Date Discussed by Care Team (MDT) not coded as Inapplicable [ICDSITE = C700 OR C701 OR C709 OR C71 OR C72 OR C75.2 OR C75.3] AND [MDTDATE <> 10/10/1010] numerator exclusion Include in the denominator measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [PSTATUS <>9] AND ([ WHODATE = 09/09/0909] OR [MDTDATE = 09/09/0909]) Include in the denominator measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion this standard. N/A denominator Exclude from the denominator measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion this standard [ICDSITE = C99.X] Brain/CNS Cancer QPI Measurability v3.0 6

7 QPI 2 Multi-Disciplinary Team Meeting QPI Title: Numerator: Patients with brain/cns cancer should be discussed by a multidisciplinary (MDT) team prior to any surgical procedure*. Proportion of patients with brain/cns cancer who are discussed at MDT meeting bee surgery. Number of patients with brain/cns cancer discussed at the MDT bee surgery. Date Discussed by Care Team (MDT) not coded as not applicable; AND Date Discussed by Care Team (MDT) is bee or equal to Date of First Surgical Procedure [MDTDATE <> 10/10/1010] AND [MDTDATE DFIRSTSURG] Denominator: All patients with Brain/CNS cancer undergoing surgery (Excluding patients who died bee first treatment). Date of Diagnosis [DIAGDATE] in range specified comparative analysis; AND Site of Origin of Primary Tumour {Brain/CNS Cancer} 1-4 coded as Brain/CNS Cancer; AND Date of First Surgical Procedure not coded as inapplicable ; AND Type of First Treatment not coded as Patient died bee treatment. [ICDSITE = C70.0 OR C70.1 OR C70.9 OR C71 OR C72 OR C75.2 OR C75.3] AND [DFIRSTSURG <> 10/10/1010] AND [FIRSTTREATTYPE <>94] numerator exclusion denominator Include in the denominator measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [MDTDATE = 09/09/0909] Include in the denominator measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion this standard. [FIRSTTREATTYPE = 99] Exclude from the denominator measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion this standard [ICDSITE = C99.X] OR [DFIRSTSURG = 09/09/0909] *Please note that surgical procedures include diagnostic biopsies. Brain/CNS Cancer QPI Measurability v3.0 7

8 b c QPI 3 Molecular Analysis QPI Title: Patients with biopsied or resected gliomas should have molecular analysis permed on the tumour tissue within 21 days of surgery to inm treatment decision making. Proportion of patients with biopsied or resected gliomas who undergo relevant molecular analysis a of tumour tissue within 21 days of surgery. Please note: This QPI measures 2 distinct elements: (i): Patients with Grade II or III gliomas who have the tumour tested combined loss of 1p/19q; and (ii): Patients with glioblastomas b who have the tumour tested MGMT c promoter methylation status. Specification (i) Numerator (i) Number of patients with a Grade II or III glioma undergoing surgery where tissue sample is tested 1p/19q within 21 days of surgery. 1P/19Q Tissue Analysis {Brain/CNS Cancer} not coded as Not Done or Insufficient Sample; and Date of 1P/19Q Tissue Analysis {Brain/CNS Cancer} minus Date of Definitive Surgery less than or equal to 21 days Denominator (i) [SAMP1P <> 03 OR 04] AND [SAMP1PDATE DSURG 21] All patients with a Grade II or III glioma undergoing surgery (No exclusions). Date of Diagnosis [DIAGDATE] in range specified comparative analysis; AND Morphology of Tumour coded as Glioma; Oligodendroglioma; AND WHO Grade coded as Grade II or Grade III ; and Date of Definitive Surgery not coded as Inapplicable. [MORPHOL = 9400/3 OR 9411/3 OR 9401/3 OR 9440/3 OR 9441/3 OR 9442/3 OR 9445/3 OR 9385/3 OR 9425/3 OR 9431/3 OR 9430/3 OR 9450/3 OR 9451/3] AND [GRADE = 2 OR 3] AND [DSURG <> 10/10/1010] WHO classification of CNS tumours (2016) uses molecular parameters in addition to histology to define tumour entities. In addition to those outlined in the QPI, relevant molecular analysis also include those outlined in 2016 World Health Organisation Classification of Tumours of the Central Nervous System. - b including subtypes (WHO Grade IV) c The O(6)-methylguanine-DNA methyltransferase (MGMT) gene a Brain/CNS Cancer QPI Measurability v3.0 8

9 Specifications (ii): Numerator (ii) Number of patients with glioblastomas undergoing surgery where tissue sample is assessed MGMT promoter hypermethylation status within 21 days of surgery. MGMT Tissue Analysis not coded as Not Done or Insufficient Sample; and Date of MGMT Tissue Analysis minus Date of Definitive Surgery less than or equal to 21 days Denominator (ii) [MGMTSAMP <> 03 OR 04] AND [MGMTSAMPDATE DSURG 21] All patients with glioblastomas undergoing surgery (No exclusions). Date of Diagnosis [DIAGDATE] in range specified comparative analysis; AND Morphology of Tumour coded as Glioblastoma, NOS; Giant cell glioblastoma; or Gliosarcoma (Glioblastoma with Sarcomatous Component); AND WHO Grade coded as Grade IV, and Date of Definitive Surgery not coded as Inapplicable. [MORPHOL = 9440/3 OR 9441/3 OR 9442/3] AND [GRADE = 4] AND [DSURG <> 10/10/1010] numerator Include in the denominator measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target (i) [SAMP1P = 99] OR [SAMP1PDATE = 09/09/0909] OR [DSURG = 09/09/0909] (ii) [MGMTSAMP = 99] OR [MGMTSAMPDATE = 09/09/0909] OR [DSURG = 09/09/0909] exclusion Include in the denominator measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion this standard. (i) and (ii) N/A denominator Exclude from the denominator measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion this standard (i) and (ii) [MORPHOL = 9999/9] OR [GRADE = 99] OR [DSURG = 09/09/0909] Brain/CNS Cancer QPI Measurability v3.0 9

10 QPI 4 Neuropathological Diagnosis QPI Title: Numerator: All pathology reports brain/central nervous system (CNS) cancer should contain full pathology inmation (including tumour type as described in World Health Organisation (WHO) Classification of CNS tumours (2016) and WHO grade where appropriate) to inm patient management. Proportion of patients with brain/cns cancer where the pathology report contains a full set of data items (as defined by the Royal College of Pathologists). Number of patients with a histological diagnosis of brain/cns cancer where histological pathology report contains all data items (as defined by relevant Royal College of Pathologists publication). Histopathology Report Complete {Brain/CNS Cancer} coded as Complete [PATHCOMPL = 1] Denominator: All patients with a histological diagnosis of brain/cns cancer (No exclusions). Date of Diagnosis [DIAGDATE] in range specified comparative analysis; AND Site of Origin of Primary Tumour {Cancer} coded as Brain/CNS Cancer; AND Most Valid Basis of Diagnosis {Cancer} coded as Histology of metastasis, or Histology of primary [ICDSITE = C700 OR C701 OR C709 OR C71 OR C72 OR C75.2 OR C75.3] AND [VALID = 6 OR 7] numerator exclusion Include in the denominator measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [PATHCOMPL = 99] Include in the denominator measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion this standard. N/A denominator Exclude from the denominator measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion this standard [ICDSITE = C99.X] OR [VALID = 99] Brain/CNS Cancer QPI Measurability v3.0 10

11 QPI 5 Pre-Treatment Magnetic Resonance Imaging (MRI) QPI Title: Numerator: Patients with brain/central nervous system (CNS) cancer should have contrast enhanced Magnetic Resonance Imaging (MRI) prior to treatment. Proportion of patients with brain/cns cancer undergoing surgery, who have a contrast enhanced MRI prior to treatment. Number of patients with brain/cns cancer undergoing surgery who receive a contrast enhanced MRI prior to treatment. MRI SCAN (Pre-treatment) coded as Yes; AND Date MRI Scan (Pre-treatment) is bee or equal to Date of First Surgical Procedure [MRI = 1] AND [MRIDATE DFIRSTSURG] Denominator: All patients with brain/cns cancer undergoing surgery (Excluding Patients unable to undergo a contrast enhanced MRI scan (e.g.pacemaker or other MRI incompatible implanted device; Claustrophobia; Patients who refuse MRI; and Patients with Contraindication to intravenous contrast medium;. Date of Diagnosis [DIAGDATE] in range specified comparative analysis; AND Site of Origin of Primary Tumour {Cancer} coded as Brain/CNS Cancer; AND Date of First Surgical Procedure not coded as inapplicable AND MRI (Pre-treatment) not coded as Patient refused investigation, Contraindication to intravenous contrast medium, or Clinically inappropriate [ICDSITE = C700 OR C701 OR C709 OR C71 OR C72 OR C75.2 OR C75.3] AND [DFIRSTSURG <> 10/10/1010] AND [MRI<> (95 OR 97 OR 98)] numerator exclusion Include in the denominator measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [MRI = 99] OR [MRIDATE] Include in the denominator measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion this standard. [MRI = 99] denominator Exclude from the denominator measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion this standard [ICDSITE = C99.X] OR [DFIRSTSURG = 09/09/0909] Brain/CNS Cancer QPI Measurability v3.0 11

12 QPI 6 Maximal Surgical Resection QPI Title: Wherever possible patients should undergo maximal surgical resection of malignant gliomas d. Numerator : Proportion of patients with malignant glioma d (with enhancing component on pre-operative imaging) who undergo surgical resection where 90% reduction in tumour volume is achieved provided it is considered consistent with safe outcome. Number of patients with resectable malignant glioma d (with enhancing component on pre-operative imaging) undergoing surgical resection where 90%* reduction in tumour volume is achieved. Reduction in Tumour Volume {Brain/CNS Cancer} coded as % [REDUCT = 5] Denominator All patients with malignant glioma d (with enhancing component on pre-operative imaging) undergoing surgical resection. (Excluding patients undergoing biopsy only d, and Patients in whom surgeons intent is partial resection / debulking surgery). Date of Diagnosis [DIAGDATE] in range specified comparative analysis; AND Morphology of Tumour coded as Anaplastic astrocytoma; Glioblastoma; Giant cell glioblastoma; Gliosarcoma; Oligodendroglioma; Anaplastic Oligodendroglioma; Oligoastrocytoma; Anaplastic Oligoastrocytoma; Anaplastic pleomorphic xanthoastrocytoma; Anaplastic ependymoma; AND Main Type of Definitive Surgery {Brain/CNS Cancer} coded as Craniotomy lesion of frontal lobe, Craniotomy lesion of temporal lobe, Craniotomy lesion of parietal lobe, Craniotomy lesion of occipital lobe, Craniotomy lesion of cerebellum, Craniotomy lesion of brain tissue - other site AND Enhancing component present on pre-operative imaging coded as yes; AND Intent of Surgery not coded as partial resection / debulking surgery [MORPHOL = 9401/3 OR 9440/3 OR 9441/3 OR 9442/3 OR 9445/3 OR 9450/3 OR 9451/3 OR 9424/3 OR 9392/3] AND [OPCODE1 OR OPCODE2 OR OPCODE3 OR OPCODE4 = A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8] AND [ENHANC = 1] AND [OPINTENT <> 2] numerator Include in the denominator measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [REDUCT = 99] Include in the denominator measurement against the target unless there is other definitive evidence that the record should be excluded. d Malignant gliomas include: Glioblastoma multime- GBM and its variants e.g. gliosarcoma) Anaplastic Astrocytoma- AA) Anaplastic pleomorphic xanthoastrocytoma Aanaplastic oligodendrogliomas Anaplastic (High-grade) ependymoma e Patients undergoing biopsy only are excluded by default due to the operation codes used within this measurability Brain/CNS Cancer QPI Measurability v3.0 12

13 exclusion Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion this standard. denominator [OPINTENT = 99] Exclude from the denominator measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion this standard (i) [MORPHOL = 9999/9] OR [OPCODE1 = 99 AND OPCODE2-4 <> (A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8) OR OPCODE2 = 99 AND OPCODE1, 3, 4 <> (A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8) OR OPCODE3 = 99 AND OPCODE 1, 2, 4 <> (A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8) OR OPCODE4 = 99 AND OPCODE1-3 <> (A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8)] OR [ENHANC = 99] *Percentage tumour reduction should be assessed by comparing pre surgical imaging to post surgical 72hr Magnetic Resonance Imaging (MRI) Brain/CNS Cancer QPI Measurability v3.0 13

14 QPI 7 Early Post-Operative Imaging QPI Title: Numerator: Patients with malignant glioma d (with enhancing component on pre-operative imaging) undergoing surgical resection should be subject to early post-operative imaging. Proportion of patients with malignant glioma d, (with enhancing component on pre-operative imaging) who receive early post operative imaging with Magnetic Resonance Imaging (MRI) within 3 days (72hrs) of surgical resection. Number of patients with malignant glioma d, (with enhancing component on pre-operative imaging) undergoing surgical resection who receive MRI within 3 days (72hrs) of surgical resection. Date of Post Surgical MRI SCAN minus Date of Definitive Surgery less than or equal to 3 [POSTMRIDATE DSURG 3] Denominator: NB Dates do not allow specification in hours All patients with malignant glioma d, (with enhancing component on pre-operative imaging), undergoing surgical resection. (Excluding Patients unable to undergo an MRI scan (e.g.pacemaker or other MRI incompatible implanted device; Cerebral aneurysm clip; Patients who refuse MRI; Contraindication to intravenous contrast medium; and Patients undergoing biopsy only e ). Date of Diagnosis [DIAGDATE] in range specified comparative analysis; AND Morphology of Tumour coded as Anaplastic astrocytoma; Glioblastoma; Giant cell glioblastoma, Gliosarcoma; Oligodendroglioma; Anaplastic Oligodendroglioma; Oligoastrocytoma; Anaplastic Oligoastrocytoma; Anaplastic pleomorphic xanthoastrocytoma; Anaplastic ependymoma; AND Main Type of Definitive Surgery {Brain/CNS Cancer} coded as Craniotomy lesion of frontal lobe, Craniotomy lesion of temporal lobe, Craniotomy lesion of parietal lobe, Craniotomy lesion of occipital lobe, Craniotomy lesion of cerebellum, Craniotomy lesion of brain tissue - other site ; AND Enhancing component present on pre-operative imaging coded as yes; AND Post Surgical MRI SCAN not coded as Patient refused investigation,, Contraindication to intravenous contrast medium, or Clinically inappropriate. [MORPHOL = 9401/3 OR 9440/3 OR 9441/3 OR 9442/3 OR 9445/3 OR 9450/3 OR 9451/3 OR 9424/3 OR 9392/3] AND [OPCODE1 OR OPCODE2 OR OPCODE3 OR OPCODE4 = A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8 ] AND [ENHANC = 1] AND [POSTMRI <> (95 OR 97 OR 98)] Include in the denominator measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as d Malignant gliomas include: Glioblastoma multime- GBM and its variants e.g. gliosarcoma) Anaplastic Astrocytoma- AA) Anaplastic pleomorphic xanthoastrocytoma Aanaplastic oligodendrogliomas Anaplastic (High-grade) ependymoma e Patients undergoing biopsy only are excluded by default due to the operation codes used within this measurability Brain/CNS Cancer QPI Measurability v3.0 14

15 numerator having met/not met the target [POSTMRIDATE = 09/09/0909] OR [DSURG = 09/09/0909] exclusion Include in the denominator measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion this standard. [POSTMRI = 99] denominator Exclude from the denominator measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion this standard [MORPHOL = 9999/9] OR [OPCODE1 OR OPCODE2 OR OPCODE3 OR OPCODE4 = 99] OR [ENHANC = 99] Brain/CNS Cancer QPI Measurability v3.0 15

16 QPI 8 Specialist Neuro-Oncology Access QPI Title: Patients with brain/central nervous system (CNS) cancer undergoing oncological treatment should be managed by a site specialist neurooncologist. Numerator: Proportion of patients with brain/cns cancer undergoing oncological treatment (chemotherapy or radiotherapy) who are managed by a specialist neuro-oncologist. Number of patients with brain/cns cancer undergoing oncological treatment (chemotherapy or radiotherapy) who are managed by specialist neuro-oncologist. Specialist Neuro-oncologist {Brain/CNS Cancer} coded as Yes [SPECNEURO = 01] Denominator: All patients with brain/cns cancer undergoing oncological treatment (chemotherapy or radiotherapy) (No exclusions). Date of Diagnosis [DIAGDATE] in range specified comparative analysis; AND Site of Origin of Primary Tumour {Cancer} coded as Brain/CNS Cancer; AND (Radiotherapy Course Type {Brain/CNS Cancer} 1-2 coded as Radical, Palliative, or Chemoradiotherapy; OR Type of Systemic Anti-Cancer Therapy (SACT) (Brain/CNS Cancer) 1-2 coded as Adjuvant, Neoadjuvant, Palliative, Chemoradiotherapy, or Biological Therapy) [ICDSITE = C700 OR C701 OR C709 OR C71 OR C72 OR C75.2 OR C75.3] AND ( [RADIO1 OR RADIO2 = 3 OR 4 OR 7] OR [CHEMTYPE1 OR CHEMTYPE2 = 1 OR 2 OR 4 OR 5 OR 7] ) numerator exclusion Include in the denominator measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [SPECNEURO = 99] Include in the denominator measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion this standard. N/A denominator Exclude from the denominator measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion this standard [ICDSITE = 99] OR [RADIO1 OR RADIO2 = 99] OR [CHEMTYPE1 OR CHEMTYPE2= 99] Brain/CNS Cancer QPI Measurability v3.0 16

17 QPI 9 Access to Oncological Treatment QPI Title: The maximum time between surgery and oncological treatment patients with high grade glioma (WHO grades III and IV) should be 6 weeks. Numerator: Denominator: numerator exclusion denominator Proportion of patients with high grade glioma (WHO grades III and IV) undergoing surgery who commence their oncological treatment (chemotherapy, radiotherapy or chemoradiotherapy) within 6 weeks of surgery. Number of patients with high grade glioma (WHO grades III and IV) who undergo oncological treatment (chemotherapy, radiotherapy or chemoradiotherapy) who commence treatment within 6 weeks of surgery. Date Treatment Started {Cancer} (Radiotherapy) 1; or Date Treatment Started Systemic Anti-Cancer Therapy (SACT) 1 minus Date of Definitive Surgery is less than or equal to 42 [RADDATE1 DSURG 42] OR [CHEMDATE1 DSURG 42] ) All patients with high grade glioma (WHO grades 3 and 4) who undergo oncological treatment (chemotherapy, radiotherapy or chemoradiotherapy) following surgery. (No exclusions) Date of Diagnosis [DIAGDATE] in range specified comparative analysis; AND Morphology of Tumour coded as Anaplastic astrocytoma; Glioblastoma; Giant cell glioblastoma, Gliosarcoma; Oligodendroglioma; Anaplastic Oligodendroglioma; Oligoastrocytoma; Anaplastic Oligoastrocytoma; Anaplastic pleomorphic xanthoastrocytoma; Anaplastic ependymoma; AND WHO Grade coded as Grade III or Grade IV; AND Main Type of Definitive Surgery {Brain/CNS Cancer} 1-4 coded as Craniotomy lesion of; frontal lobe, temporal lobe, parietal lobe, occipital lobe, cerebellum or brain tissue other site, biopsy only AND Radiotherapy Course Type {Brain/CNS Cancer} 1 coded as radical or chemoradiotherapy; or Type of Systemic Anti-Cancer Therapy (SACT) {Brain/CNS Cancer} 1 coded as adjuvant or chemoradiotherapy. [MORPHOL = 9401/3 OR 9440/3 OR 9441/3 OR 9442/3 OR 9445/3 OR 9450/3 OR 9451/3 OR 9424/3 OR 9392/3] AND [GRADE = 3 OR 4] AND ([OPCODE1 OR OPCODE2 OR OPCODE3 OR OPCODE4 = A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8 OR 98]) AND ([RADIO1 =3 or 7] OR [CHEMTYPE1 = 1 or 5]) Include in the denominator measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target ([RADDATE1 = 09/09/0909] AND [CHEMDATE1 = 09/09/0909]) OR [DSURG = 09/09/0909] Include in the denominator measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion this standard. N/A Exclude from the denominator measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion this standard [MORPHOL = 9999/9] OR [GRADE = 99] OR [OPCODE1 = 99 AND OPCODE2-4 <> (A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8 OR 98) OR OPCODE2 = 99 AND OPCODE1, 3, 4 <> (A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8 OR 98) OR Brain/CNS Cancer QPI Measurability v3.0 17

18 OPCODE3 = 99 AND OPCODE 1, 2, 4 <> (A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8 OR 98) OR OPCODE4 = 99 AND OPCODE1-3 <> (A02.1 OR A02.2 OR A02.3 OR A02.4 OR A02.5 OR A02.8 OR 98)] OR [(RADIO1 = 99 AND CHEMTYPE1 <>(1 OR 5)] OR [(CHEMTYPE1 = 99 AND RADIO1 <> (3 OR 7)] Brain/CNS Cancer QPI Measurability v3.0 18

19 QPI 10 Radical Radiotherapy Planning Process QPI Title: Numerator: The radical f radiotherapy planning process patients with brain/central Nervous System (CNS) cancer should include Magnetic Resonance Imaging (MRI) fusion. Proportion of patients with brain/cns cancer undergoing radical radiotherapy whom the radiotherapy planning process includes MRI fusion. Number of patients with primary brain/cns cancer undergoing radical radiotherapy whom radiotherapy planning includes MRI fusion. MRI Fusion in Radiotherapy Planning {Brain/CNS Cancer} coded as Yes MRI fusion included [MRIFUS = 1] Denominator: All patients with brain/cns cancer undergoing radical radiotherapy (Excluding Patients unable to undergo an MRI scan e.g. Pacemaker or other MRI incompatible implanted device; Cerebral aneurysm clip; Patients who refuse MRI, Contraindication to intravenous contrast medium) Date of Diagnosis [DIAGDATE] in range specified comparative analysis; AND Site of Origin of Primary Tumour {Cancer} coded as Brain/CNS Cancer;; AND (Radiotherapy Course Type {Brain/CNS Cancer} 1-2 coded as Radical or Chemoradiotherapy; AND MRI Fusion in Radiotherapy Planning {Brain/CNS Cancer} not coded as Clinically inappropriate or Not applicable or Patient Refused or Contraindication to Intravenous Contrast Medium [ICDSITE = C700 OR C701 OR C709 OR C71 OR C72 OR C75.2 OR C75.3] AND [RADIO1 OR RADIO2 = 3 or 7] AND [MRIFUS <> 95 OR 96 OR 97 OR 98] numerator exclusion Include in the denominator measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [MRIFUS = 99] Include in the denominator measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion this standard. [MRIFUS = 99] denominator Exclude from the denominator measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion this standard [ICDSITE = 99] OR [RADIO1 OR RADIO2 = 99] f Radical is defined as radiotherapy courses where 15 fractions are delivered. Brain/CNS Cancer QPI Measurability v3.0 19

20 QPI 11 Seizure Management QPI Title: Numerator Patients with brain/central nervous system (CNS) cancer presenting with seizures at diagnosis should be seen by a neurologist and/or a named epilepsy specialist nurse (ESN). Proportion of patients with brain/cns cancer presenting with seizures at diagnosis who are seen by a neurologist or a named ESN within four weeks of diagnosis. Number of patients presenting with seizures at diagnosis seen by a neurologist or a named ESN within four weeks of diagnosis. Seen by Neurologist and/or Nurse with Expertise in Epilepsy Management {Brain/CNS Cancer} coded as seen by Named Epilepsy Specialist Nurse (ESN) or Neurologist or Seen by both (Named Epilepsy Specialist Nurse and Neurologist); AND Date seen by Neurologist and/or Named Epilepsy Specialist Nurse minus Date of Diagnosis less than or equal to 28 days.. [EPILNESN = 1 OR 2 OR 3] AND [EPILNESNDATE DIAGDATE 28] Denominator All brain/cns cancer patients presenting with seizures at diagnosis (No exclusions) Date of Diagnosis [DIAGDATE] in range specified comparative analysis; AND Site of Origin of Primary Tumour {Cancer} coded as Brain/CNS Cancer; AND Seizure Presentation coded as Yes [ICDSITE = C700 OR C701 OR C709 OR C71 OR C72 OR C75.2 OR C75.3] AND [EPIL = 01] numerator exclusion Include in the denominator measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [EPILNESN = 99] OR [EPILNESNDATE = 09/09/0909] Include in the denominator measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion this standard. N/A denominator Exclude from the denominator measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion this standard [ICDSITE = C99.X] OR [EPIL = 99] Brain/CNS Cancer QPI Measurability v3.0 20

21 QPI 12 Key Worker QPI Title: Patients with brain/central nervous system (CNS) cancer should have an identified key worker to co-ordinate care across the patient pathway. Numerator Proportion of patients with brain/cns cancer who have an identified key worker by the first MDT meeting. Number of patients with brain/cns cancer who have an identified key worker by the first MDT meeting. Key Worker {Brain/CNS} coded as Yes [KEYWORK = 1] Denominator All patients with Brain/CNS cancer (Excluding patients undergoing supportive care). Date of Diagnosis [DIAGDATE] in range specified comparative analysis; AND Site of Origin of Primary Tumour {Brain/CNS Cancer} 1-4 coded as Brain/CNS Cancer; AND Type of First Cancer Treatment {Brain / CNS} not coded as supportive care. [ICDSITE = C700 OR C701 OR C709 OR C71 OR C72 OR C75.2 OR C75.3] AND [FIRSTTREATTYPE <> 7] numerator exclusion Include in the denominator measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [KEYWORK = 99] Include in the denominator measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion this standard. [FIRSTTREATTYPE = 99] denominator Exclude from the denominator measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion this standard [ICDSITE = C99.X] Brain/CNS Cancer QPI Measurability v3.0 21

22 QPI Day Mortality after Treatment Brain/CNS Cancer QPI Title: Numerator 30 day mortality following treatment brain/central nervous system (CNS) cancer. Proportion of patients with brain/cns cancer who die within 30 days of treatment (surgery, radiotherapy and chemotherapy) brain/cns cancer. Number of patients with brain/cns cancer who undergo treatment that die within 30 days of treatment. Date of Death is not coded as inapplicable and is within 30 days of date of active treatment [either DSURG / RCOMPDATE / CHEMENDATE] Surgery [DOD <> 10/10/1010] AND [DOD DSURG 30] Radiotherapy [DOD <> 10/10/1010] AND (([RADIO1 = 03 OR 04] AND [DOD RCOMPDATE1 30]) OR ([RADIO2 = 03 OR 04] AND [DOD RCOMPDATE2 30] )) Chemotherapy [DOD <> 10/10/1010] AND (([CHEMTYPE1 = 01 OR 02 OR 04] AND [DOD CHEMENDATE1 30]) OR ([CHEMTYPE2 = 01 OR 02 OR 04] AND [DOD CHEMENDATE2 30] )) Chemoradiotherapy ( ([CHEMTYPE1 = 5] AND [DOD - CHEMENDATE1 30] AND [CHEMENDATE1 <> 10/10/1010] ) OR ([CHEMTYPE2 = 5] AND [DOD CHEMENDATE2 30] AND [CHEMENDATE2 <> 10/10/1010] ) OR ([RADIO1 = 7] AND [DOD RCOMPDATE1 30] AND [RCOMPDATE1 <> 10/10/1010] ) OR ([RADIO2 = 7] AND [DOD RCOMPDATE2 30] AND [RCOMPDATE2 <> 10/10/1010] ) ) AND [DOD <> 10/10/1010] Brain/CNS Cancer QPI Measurability v3.0 22