Cancer Control Indicators

Transcription

1 CENTRAL CANCER NETWORK Cancer Control Indicators February 2011 Central Region s Technical Advisor y Services Limited (TAS)

2 Cancer Control Indicators - Central Cancer Network Prepared by: Central Region s Technical Advisory Services Limited (TAS) PO Box Wellington Phone Fax Info@centraltas.co.nz Central Region s Technical Advisory Services Limited Copyright Statement The content of this document is protected by the Copyright Act The information provided on behalf of the Central Cancer Network may be reproduced without further permission, subject to the following conditions. You must reproduce the information accurately, using the most recent version. You must not use the material in a manner that is offensive, deceptive or misleading. You must acknowledge the source and copyright status of the material. While every effort has been made to ensure its accuracy, TAS and the Central Cancer Network will not be liable for provision of any incorrect or incomplete information.

3 CONTENTS Contents Executive Summary... 3 Background Data Sources Cancer Registrations Tobacco Control Breastfeeding HPV Immunisation Programme Sun Protection Screening Breast Screening Cervical PET Scans Lung Tumour Stream Indicators Bowel Tumour Stream Indicators Waiting Times Radiation Oncology Waiting Times Medical Oncology Implementation of the Liverpool Care Pathway for the Dying Patient (LCP) Abbreviations DHB Dashboard: Capital & Coast DHB Dashboard: Hawke s Bay DHB Dashboard: DHB Dashboard: DHB Dashboard: DHB Dashboard: DHB Dashboard: Wairarapa DHB Dashboard: CANCER CONTROL INDICATORS - CENTRAL CANCER NETWORK : FEBRUARY

4 EXECUTIVE SUMMARY Executive Summary This report presents a key set of cancer performance indicators which will assist the CCN, local cancer networks and DHBs to monitor the delivery of cancer services at a regional and local level. ASH Year 10 survey data by CCN DHB for the years 1999 to 2009 show that smoking prevalence is decreasing for this age group (14-15 years). Within the CCN region, 21 of the 24 local authorities have smokefree public places policies (88%). Tobacco control In quarter two, 2010/11 five of the region s DHBs continued to make positive gains against the percentage of identified hospitalised smokers who are offered help and advice to quit smoking. As of this quarter, both and Hawke s Bay were above the 80% target for July 2010 and heading towards the July 2011 target of 90%. Wairarapa has consistently had results above 80%, but results for quarter two were not available at the time of writing this report. The 20% gain achieved by DHB this quarter was the largest across all DHBs nationwide. Two CCN DHBs saw a decrease in achievement in quarter two, and both are working towards improving performance for quarter three. Primary care better help to quit data is not likely to be publically available until October or November Presented in this February 2011 report for the first time is some data sourced from the Tuatua Tika Report (Straight talk about Pacific Peoples and smoking), Pacific Tobacco Control Report Breastfeeding The breastfeeding section of this report has been updated with 2009 data, allowing summary data to be presented for the period As of 2009, the majority of DHBs in the CCN region are yet to meet the national breastfeeding targets at six weeks, with even poorer results for Māori. Rates are better compared to targets for three and six months. HPV immunisation Different DHBs within the CCN region are concentrating their HPV immunisation efforts on different age cohorts, and hence improvements since the August 2010 indicators report vary. For the cohort of girls born in 1997, all CCN DHBs with the exception of have coverage rates as of December 2010 which are above the national average for all three doses, but still below the national targets. While s coverage for all three doses for girls born in 1997 are below both the national averages and targets, they like all other CCN DHBs are showing an improvement in coverage for dose 3 between June and December Changes for doses 1 and 2 vary between DHBs. CANCER CONTROL INDICATORS - CENTRAL CANCER NETWORK : FEBRUARY

5 EXECUTIVE SUMMARY Sun protection This section focuses on the SunSmart Schools Accreditation Programme (SSAP). The SSAP provides accreditation for New Zealand schools that have developed and implemented a sun protection policy and sunsafe practices for terms 1 and 4, which meet the Cancer Society of New Zealand s minimum criteria. Compared to the national average, the CCN region has a lower percentage of SunSmart accredited schools, but a slightly higher percentage of applications pending. The percentage of accredited schools, plus those with applications pending is 25% for the region (and 28% nationally) as at 31 December For both the region and nationally, this is an increase of 3% since 31 July The main barriers for schools are the cost of shade development and sunscreen. Screening - breast The data presented in this report coves the same period as that reported in the August 2010 CCN Indicators Report as BSA is implementing some changes to their population data. The data presented has been sourced directly from BSA while that presented in the August report was sourced from providers so there will be some minor differences. Progress in coverage has been made in the past three years resulting in an increase in participation in hard to reach populations so that as of June 2010, all but one CCN DHB either met, exceeded or were within 2% of the national target of 70% for their total populations. For women rescreened by BreastScreen Coast to Coast and BreastScreen Central in the six months and two years predating December 2009 (latest data available from NSU), rescreen targets were exceeded, both for women rescreened within 27 months and within months. In the six months and two years predating December 2009, both BreastScreen Coast to Coast and BreastScreen Central exceeded the targets for initial and subsequent invasive cancer detection. Screening - cervical As of September 2010, two CCN DHBs are just shy (by 1% or less) of meeting the 75% target for cervical screening coverage for their total populations. All other CCN DHBs exceed the target. PET scans by DHB In total across the CCN region between July and December 2010, the number of PET scans by approved clinical indication totalled 113 but note that this figure may exclude some volumes for DHB. There were 30 PET scans funded outside of the national clinical indications, giving a total of 143 PET scans for the region between July and December CANCER CONTROL INDICATORS - CENTRAL CANCER NETWORK : FEBRUARY

6 EXECUTIVE SUMMARY Lung and bowel tumour stream indicators To be updated in the August reports. Waiting times radiation oncology In December 2010 the health target for wait time from FSA to first treatment for radiation oncology changed from six weeks to four weeks. Both cancer centres in the CCN region met this target of four weeks for all their patients in December. Both centres had been regularly meeting the six week target prior to this. Both cancer centres have plans in place in anticipation of continuing to meet the four week target. Waiting times medical oncology.the Medical Oncology Working Group developed Medical Oncology Prioritisation Criteria for use sector wide from 1 July Both cancer centres in the CCN region are working towards implementing these and putting in place IT processes to support this. Liverpool care of the dying pathway (LCP) implementation The LCP is an evidence-based, integrated care pathway that empowers healthcare professionals to deliver best practice care to dying patients, and their families/whānau, in the last days and hours of life. Implementation across organisations including hospices, hospitals, residential care and community facilities varies by DHB, with the first DHB in the country to have completed implementation. As of 17 January 2011, there are 84 organisations in the CCN region registered for LCP implementation with the National LCP Office. This is an increase of 17 organisations (25%) since 21 June There are 267 organisations registered nationally, of which the 84 in the CCN region make up 31%. Ethnicity comparisons This section provides a brief overview of trends across the indicators for Māori and Pacific Peoples. Please note that the following indicators were not analysed by ethnicity: sun protection, PET scans by DHB, and LCP implementation. Better help to quit data by ethnicity shows that for four CCN DHBs, the percentage of identified hospitalised smokers offered help and advice to quit is higher for Māori than for all patients (by between 1% and 16%). For the four DHBs where the result for Māori is lower, the difference ranges from 2% to 4%. Six DHBs reported a result for Pacific Peoples and for all but two of these, the result for Pacific Peoples was higher than that for the total population (ranging from 1% to 13%). For the two DHBs with a lower result for Pacific Peoples, this was by 5% and 6%. Based on data reported in the Tuatua Tika Report only two CCN DHBs have a smoking prevalence for Pacific Peoples which is less than the CANCER CONTROL INDICATORS - CENTRAL CANCER NETWORK : FEBRUARY

7 EXECUTIVE SUMMARY average for New Zealand. In only one CCN DHB is the percentage of Pacific non-smokers exposed to second hand smoke lower than that for New Zealand. Note results not tested for statistical significance. Māori girls born in 1997 and have coverage rates for HPV which match or are higher than that for the total population in many DHBs. BSA remains focussed on increasing Māori and Pacific coverage and reducing inequalities overall and this is a contractual focus for providers. The relative change in coverage for all DHBs between June 2008 and June 2010 was higher for Māori and Pacific women than that for those of Other ethnicities. There is very little difference in BSA coverage rates between the CCN region and New Zealand for Māori women and those of Other ethnicities. However the regional average for Pacific women is lower than that for the country. Although inequalities in NCSP coverage rates still exist for Māori, Pacific and Asian women, an upward trend in coverage is occurring in the majority of the DHBs for these ethnic groups, with greatest gains for Pacific and Asian women. Combined results for the region show that the regional average for Asian and Māori women is higher than that for the country while that for Pacific women is lower. Analysis by ethnicity of average wait time between radiation oncology referral and FSA shows that there is more variation for Māori (both centres) and Pacific Peoples (WBCC) than for the total population. This is influenced by the smaller number of Māori and Pacific Peoples, so that a longer or shorter wait by one individual can have a large effect on the average for that population. Geographic inequalities DHB dashboards are presented in the Appendix of this report. These highlight trends and relativity amongst DHBs across a series of indicators. Commentary specific to each DHB is also included. CANCER CONTROL INDICATORS - CENTRAL CANCER NETWORK : FEBRUARY

8 EXECUTIVE SUMMARY The following tables present a summary of some indicators ranked by DHB (where a ranking of 1 is the most favourable). Not all indicators are presented in this format as the tables have been limited to those indicators most suitable to this type of representation. Individual dashboards for each of the eight CCN DHBs are presented in the Appendix. Table 1: Matrix of tobacco control indicators by CCN DHBs Rank 1 is the most favourable BETTER HELP TO QUIT HOSPITALISED PATIENTS, QUARTER /11 ASH YEAR 10 SURVEY (2009) % smokers provided with advice and help to quit, total pop (88%) Hawke's Bay (83%) (69%) (67%) Capital & Coast (62%) (59%) (55%) % smokers provided with advice and help to quit, Māori (91%) Hawke's Bay (81%) (71%) (64%) Capital & Coast (63%) (55%) (54%) Smoking prevalence, total pop (13%) (13%) Capital & Coast (15%) (16%) (20%) Hawke's Bay (21%) (27%) Smoking prevalence, Māori (24%) (27%) (33%) Capital & Coast (37%) Hawke's Bay (41%) (43%) Youth daily smoking prevalence (4%) Capital & Coast (4%) Wairarapa (5%) (5%) Hawke's Bay (7%) (7%) (8%) At the time of writing this report, the Quarter 2, 2010/11 result for Wairarapa DHB had not been finalised, due to a backlog of coding for December Prevalence data not reported for Māori by DHB. Data for Pacific Peoples is not reported in this table due to very small numbers in some DHBs. (8%) Youth regular smoking prevalence Capital & Coast (8%) (9%) Wairarapa (10%) (10%) (13%) Hawke's Bay (13%) (13%) (14%) Youth never smoked prevalence Capital & Coast (72%) (66%) (62%) (58%) (57%) Wairarapa (57%) (57%) Hawke's Bay (55%) Youth with parental smokers Capital & Coast (27%) (37%) (40%) Hawke's Bay (41%) (43%) (44%) Wairarapa (44%) (45%) Youth who live in a home with smoking inside Capital & Coast (14%) (18%) (20%) Hawke's Bay (20%) (24%) (25%) Wairarapa (26%) (28%) CANCER CONTROL INDICATORS - CENTRAL CANCER NETWORK : FEBRUARY

9 EXECUTIVE SUMMARY Table 2: Matrix of breastfeeding indicators by CCN DHBs Rank 1 is the most favourable Full & exclusive breastfeeding rate at 6 weeks, 2009 (total population)* Full & exclusive breastfeeding rate at 6 weeks, 2009 (Māori)* Full & exclusive breastfeeding rate at 6 weeks, 2009 (Pacific)* Full & exclusive breastfeeding rate at 3 months, 2009 (total population)* Full & exclusive breastfeeding rate at 6 months, 2009 (total population)* 1 (76%) (72%) (89%) Capital & Coast (65%) Capital & Coast (39%) 2 Capital & Coast (72%) (68%) Hawke's Bay (68%) (61%) (39%) 3 (72%) Capital & Coast (64%) (67%) Wairarapa (54%) Hawke's Bay (28%) 4 Hawke's Bay (68%) Wairarapa (62%) Wairarapa (67%) Hawke's Bay (53%) Wairarapa (25%) 5 Wairarapa (67%) Hawke's Bay (57%) Capital & Coast (57%) (53%) (21%) 6 (60%) (57%) (55%) (50%) (20%) 7 (59%) (57%) (50%) (49%) (18%) 8 (58%) (46%) (47%) (48%) (18%) * Note that rates are based on Plunket data only and exclude other Well Child/Tamariki Ora providers. CANCER CONTROL INDICATORS - CENTRAL CANCER NETWORK : FEBRUARY

10 EXECUTIVE SUMMARY Table 3: Matrix of HPV immunisation coverage, girls born in 1997, by CCN DHBs Rank 1 is the most favourable Total population (57%) (57%) Capital & Coast (56%) Hawke's Bay (56%) (56%) Wairarapa (55%) (51%) (47%) Māori DOSE 1 DOSE 2 DOSE 3 (78%) Hawke's Bay (74%) (74%) (67%) (61%) Capital & Coast (57%) Wairarapa (57%) (51%) Pacific Peoples Wairarapa (120%) Hawke's Bay (82%) (76%) Capital & Coast (76%) (68%) (45%) (33%) (33%) Total population (56%) Hawke's Bay (55%) (55%) (54%) Capital & Coast (54%) Wairarapa (54%) (49%) (45%) Māori (76%) (73%) Hawke's Bay (72%) (65%) (59%) Wairarapa (55%) Capital & Coast (54%) (50%) Pacific Peoples Wairarapa (120%) Hawke's Bay (82%) Capital & Coast (76%) (70%) (64%) (45%) (33%) (33%) Total population (54%) Wairarapa (53%) Hawke's Bay (51%) Capital & Coast (50%) (50%) (49%) (49%) (42%) Māori (74%) (69%) Hawke's Bay (66%) (57%) Wairarapa (54%) (51%) Capital & Coast (48%) (46%) Pacific Peoples Wairarapa (120%) Hawke's Bay (78%) Capital & Coast (70%) (61%) (60%) (45%) (33%) (33%) CANCER CONTROL INDICATORS - CENTRAL CANCER NETWORK : FEBRUARY

11 EXECUTIVE SUMMARY Table 4: Matrix of cancer screening indicators by CCN DHBs Rank 1 is the most favourable Coverage* (total population) Wairarapa 75% Coverage* (Māori) Wairarapa 81% BSA Coverage* (Pacific Peoples) Wairarapa 73% Difference in coverage rate between Māori & Other Wairarapa 6% Difference in coverage rate between Pacific & Other Wairarapa -1% Coverage** (total population) 89% Coverage** (Māori) 67% Coverage** (Pacific Peoples) 89% NCSP Coverage** (Asians) Wairarapa 87% Difference in coverage rate between Māori & Other -21% Difference in coverage rate between Pacific & Other -4% Difference in coverage rate between Asian & Other Wairarapa (3,911/5,215) (314/390) (33/45) (81% - 74%) (73% - 74%) (24,648/27,841) (2,853/4,238) (172/194) (136/157) (59% - 80%) (89% - 93%) (87% - 87%) 73% 66% 73% Capital & Coast -7% -2% Wairarapa 82% 63% Wairarapa 64% 76% -23% Wairarapa -23% 0% (10,795/14,790) (922/1,390) (29/40) (62% - 69%) (73% - 75%) (8,519/10,406) (3,813/6,042) (107/167) (535/704) (63% - 86%) (64% - 87%) (74% - 86%) 73% 63% 70% -8% -4% Capital & Coast 80% 59% 62% 74% -25% (9,202/12,610) (734/1,160) (49/70) (66% - 74%) (70% - 74%) (71,460/88,862) (3,684/6,204) (1,921/3,075) (2,418/3,285) (57% - 82%) (62% - 86%) (76% - 93%) 73% Capital & Coast 62% 63% -11% -11% 80% Wairarapa 59% 58% 63% -26% -24% -25% -13% -17% (5,492/7,530) (1,136/1,820) (505/800) (63% - 74%) (63% - 74%) (31,298/39,210) (978/1,649) (108/187) (230/367) (67% - 93%) (55% - 80%) (63% - 82%) 69% 57% 53% -14% -18% Hawke's Bay 80% Capital & Coast 59% Hawke's Bay 57% 61% Wairarapa -27% -34% -19% (12,965/18,680) (1,002/1,750) (127/240) (57% - 71%) (53% - 71%) (32,881/41,283) (5,034/8,518) (678/1,190) (150/245) (59% - 87%) (48% - 82%) (50% - 80%) Hawke's Bay 68% 53% 50% -19% Capital & Coast -22% 76% 59% 55% Capital & Coast 56% Capital & Coast -31% Hawke's Bay -34% -30% Capital & Coast -34% (12,461/18,230) (947/1,790) (20/40) (53% - 72%) (48% - 69%) (9,074/11,948) (4,414/7,493) (551/997) (5,653/10,118) (59% - 90%) (57% - 91%) (56% - 90%) Capital & Coast 68% 52% Hawke's Bay 49% Hawke's Bay -20% -22% 74% 57% Capital & Coast 52% Hawke's Bay 53% Hawke's Bay -35% Capital & Coast -38% (18,790/27,690) (581/1,110) (143/290) (51% - 71%) (50% - 72%) (34,055/45,736) (2,514/,4447) (3,447/6,622) (742/1,391) (56% - 91%) (52% - 90%) (61% - 97%) 65% Hawke's Bay 51% Capital & Coast 48% -23% Hawke's Bay -22% 74% Hawke's Bay 56% 48% 50% -37% -39% -35% Hawke's Bay -38% (3,109/4,790) (1,399/2,720) (778/1,630) (52% - 75%) (49% - 71%) (12,368/16,716) (5,948/10,639) (155/322) (1,352/2,679) (59% - 97%) (58% - 97%) (53% - 91%) * BSA 24 month coverage to June Target 70%. Data has been sourced directly from the National Screening Unit and may differ to that presented in the CCN August 2010 Indicators Report which was sourced directly from providers. ** NCSP 36 month coverage to September Target 75%. Data for Māori, Pacific and Asian woman may be influenced by small number bias in some DHBs. CANCER CONTROL INDICATORS - CENTRAL CANCER NETWORK : FEBRUARY

12 EXECUTIVE SUMMARY Table 5: Matrix of cancer radiation oncology waiting time indicators by CCN DHBs Rank 1 is the most favourable RADIATION ONCOLOGY: Average wait time from referral to assessment (days) Oct 2010 Nov 2010 Dec 2010 (6.3) (6.6) (10.3) (10.8) Capital & Coast (12.5) Wairarapa (WBCC)* (15.0) Hawke's Bay (18.9) (20.6) Wairarapa (RCTS)* (21.0) Wairarapa (RCTS)* (5.0) (5.9) (6.3) (11.4) (11.5) Hawke's Bay (14.8) Capital & Coast (15.1) (18.1) Wairarapa (WBCC)* (75.0)** Wairarapa (WBCC)* (3.7) (8.3) (8.5) (9.6) (10.2) (10.6) Wairarapa (RCTS)* (11.4) Capital & Coast (12.8) Hawke's Bay (13.9) * Note that for radiation oncology Wairarapa is presented in the table twice as patients are regularly treated at both WBCC and RCTS. ** The spike for Wairarapa patients treated at WBCC in November is due to a delay in a patient being seen as a result of clinics in the Wairarapa being held monthly, and patient being seen in November instead of October. A review of the patient record shows that the appointment management was appropriate. Please refer to the main document for wait times from FSA to treatment. CANCER CONTROL INDICATORS - CENTRAL CANCER NETWORK : FEBRUARY

13 INTRODUCTION: Background Background The Central Cancer Network (CCN) is one of four regional cancer networks established to facilitate a number of the initiatives contained in the Cancer Control Strategy Action Plan The CCN region encompasses the following eight District Health Board (DHB) areas:,, Hawke s Bay,,, Wairarapa,, Capital & Coast. Nelson/Marlborough (Southern Cancer Network) also links with CCN activity for specific patient flows into the Central Region. Similarly and link to Midland Cancer Network as appropriate. The focus of the cancer networks is to undertake regional leadership, facilitation and co-ordination roles with respect to the initiatives in the cancer action plan. Within this role the CCN is tasked with identifying and addressing service improvement opportunities within the region with respect to cancer control. The following responsibilities are included in the Terms of Reference for the CCN Governance Group: To develop and monitor key indicators which provide a view of the health of cancer services in the region To provide advice to planners and funders of cancer services. 1 Cancer Control Taskforce. The New Zealand Cancer Control Strategy: Action Plan March Wellington. Ministry of Health. A key set of cancer performance indicators will assist both CCN and local cancer networks to monitor the delivery of cancer services at a regional and local level. These indicators will form part of an overall outcomes monitoring framework as identified in the CCN Strategic Plan. The CCN has a contract with Central Region s Technical Advisory Services Limited (TAS) for analytical support. As part of this contract TAS has worked with the sector to develop the indicators presented in this report. Where appropriate, commentary has been sourced from service providers or sector experts. An advisory group has also been established for this work. The indicators will be updated on a six monthly cycle with reports circulated to the CCN Governance Group, local cancer networks and wider stakeholders in February and August of each year. Readers should note that while every effort has been made to ensure the accuracy of data contained in this report, the source data still belongs to the individual providers. As such, responses to in-depth questions relating to either the data contained in this report or to the provision of the actual service, will need to be obtained from the respective service provider/s. For general enquiries please Rebecca McDowell at TAS (rebecca_mcdowell@centraltas.co.nz). CANCER CONTROL INDICATORS - CENTRAL CANCER NETWORK : FEBRUARY

14 INTRODUCTION: Background Scope of this report This is the third six monthly CCN indicators report, with previous reports dated February 2010 and August While the reports continue to evolve, major indicator research and development will precede the August reports. The August reports will also include several indicators which will only be updated on an annual basis (e.g. ASH Year 10 survey, and the lung and bowel waiting times and MDM indicators, including colonoscopy waiting times). Noted additions to this February 2011 report are: Inclusion of the 2010/11 DAP targets. Data from Tuatua Tika - Pacific Tobacco Control Report 2010 Updated breastfeeding data for Detection data for breast screening (note that no new breast screening data since the August 2010 report is available for inclusion in this report). Narrative to accompany the DHB dashboards. It again needs to be recognised that data for some desired indicators is not (yet) readily available. This relates in particular to the lung and bowel tumour stream indicators around wait times, medical oncology waiting times and primary care data for better help for smokers to quit. More outcome focused indicators such as those around cancer registrations and cancer survival rates will be included in the CCN health needs assessment (HNA) cycle. The inaugural HNA was finalised in January 2009 and will be updated approximately three yearly. This cycle will also coincide with many of the indicators around healthy eating healthy action (HEHA), tobacco control and sun protection which are surveyed triennially. Proposed future indicators The intention is to build upon the suite of indictors included in this report every six months. The project team and advisory group will consider the following indicators for inclusion in the August 2011 report: Lung and bowel tumour stream indictors, including waiting times. Medical oncology waiting times Colposcopy data relating to the national cervical screening programme Specific audit analysis, e.g. o Gynae oncology pathway o Dental services for head and neck cancer patients Workforce monitoring data Access to diagnostics. CANCER CONTROL INDICATORS - CENTRAL CANCER NETWORK : FEBRUARY

15 INTRODUCTION: Data sources Data Sources For each indicator included in this report, the following table presents the data sources and the time period covered. Table 6: Data sources for the cancer control indicators Indicator name Data source Time period for data reported in this document Cancer registrations All malignant cancers Lung cancer Bowel cancer New Zealand Cancer Registry (NZCR) New Zealand Cancer Registry (NZCR) New Zealand Cancer Registry (NZCR) Tobacco control Better help to quit hospitalised smokers Smoking prevalence hospitalised smokers Prevalence of smoking for Pacific Peoples Prevalence of smoking for Māori ASH Year 10 survey indicators Local authority smokefree public places Ministry of Health and CCN DHBs CCN DHBs Tuatua Tika - Pacific Tobacco Control Report 2010 Census 2006 ASH Year 10 survey Smokefree Councils website and individual local authorities Q3 and Q4, 2009/10 and Q1 and Q2, 2010/11 Q3 and Q4, 2009/10 and Q1 and Q2, 2010/11 Census 2006 and NZHS 2006/07 Census to 2009 Data compiled June/July 2010 Breastfeeding Rates of exclusive and full breastfeeding Ministry of Health who source from Plunket. Note other Well (five years) Child/Tamariki Ora provider data not provided. HPV immunisation Rate of coverage for HPV dose 1, HPV dose 2, and HPV HPV Group, Ministry of Health September 2008 to December 2010 (28 months) dose 3 for young women Sun protection SunSmart accredited schools Schools who have applied for SunSmart accreditation but SunSmart Schools Accreditation Programme SunSmart Schools Accreditation Programme As of 31 December 2010 As of 31 December 2010 still to be accredited Screening breast 24 month coverage of eligible population Rescreen profiles Detection rates National Screening Unit (NSU) National Screening Unit (NSU) National Screening Unit (NSU) June 2008, 2009, 2010 January 2008 to December 2009 January 2008 to December 2009 CANCER CONTROL INDICATORS - CENTRAL CANCER NETWORK : FEBRUARY

16 INTRODUCTION: Data sources Indicator name Data source Time period for data reported in this document Screening cervical 36 month coverage of eligible population New NCSP register - National Screening Unit (NSU) Sep 2008, March 2009, Sep 2009, March 2010, Sep 2010 PET scans by DHB Number of PET scans by each clinical indication, by domicile DHB Number of PET scans outside of national clinical Ministry of Health via DHB reporting Ministry of Health via DHB reporting February to June 2010, and July to December 2010 February to June 2010, and July to December 2010 indications, by domicile DHB Lung tumour stream Indicators to be reported in August 2011 report Not applicable Not applicable Bowel tumour stream Indicators to be reported in August 2011 report Not applicable Not applicable Waiting times radiation oncology Average wait time from referral to FSA % of patient treatments meeting the health target for time Cancer Centres (WBCC & RTCS) Cancer Centres (WBCC & RTCS) January 2010 to December 2010 (12 months) January 2010 to December 2010 (12 months) from FSA to treatment Waiting times medical oncology Prioritisation Criteria Medical Oncology Work Group For use sector wide from 1 July 2010 Liverpool care of the dying pathway implementation LCP registration trends National LCP Office As at 17 January 2011 CANCER CONTROL INDICATORS - CENTRAL CANCER NETWORK : FEBRUARY

17 # registration (DHBs) # registrations (CCN) # registration (DHBs) # registrations (CCN) # registration (DHBs) # registrations (CCN) INTRODUCTION: Cancer registrations Cancer Registrations Figure 2: Number of lung cancer registrations, CCN DHBs, The following graphs have been included in this report to provide a brief update on the status of cancer registrations across the CCN DHBs. The latest 10 years of available data is presented for all malignant cancers ( ), plus lung cancer and bowel cancer ( ). Lung and bowel cancer are shown in detail as these are two cancer tumour streams of current focus note they have a later years worth of data available. This analysis is included to provide context for the other indicators presented in this report (e.g. a proxy for demand). More detailed analysis including age standardised rates will be presented when the HNA is updated in Figure 1: Number of malignant cancer registrations, CCN DHBs, C&C HB HV MC TAI TAR WAI WHA CCN C&C HB HV MC TAI TAR WAI WHA CCN Figure 3: Number of bowel cancer registrations, CCN DHBs, C&C HB HV MC TAI TAR WAI WHA CCN CANCER CONTROL INDICATORS - CENTRAL CANCER NETWORK : FEBRUARY

18 PREVENTION: Tobacco control Tobacco Control Introduction Tobacco smoking is a major health problem in New Zealand, responsible for almost 5,000 deaths each year. In addition to premature deaths, smoking causes significant morbidity, and contributes to health inequalities in New Zealand. The three key objectives of tobacco control in New Zealand are to reduce smoking initiation, to increase quitting and to reduce exposure to second-hand smoke. The Ministry of Health introduced a new health target in 2009/10 better help for smokers to quit. The national health target better help for smokers to quit is designed to prompt providers to routinely ask about smoking status as a clinical vital sign and then to provide brief advice and offer quit support to current smokers (ABC Programme). There is strong evidence that brief advice is effective at prompting quit attempts and long term quit success. The quit rate is improved further by the provision of effective cessation therapies pharmaceuticals, in particular nicotine replacement therapy (NRT), and telephone or face to face support. In addition to the actual implementation of the ABC programme this target requires new data collection and changes in coding practice. Along with reporting the percentage of hospitalised smokers offered help and advice to quit smoking, DHBs also report to the Ministry of Health the prevalence of hospitalised smokers. This data is presented in this report for the second time. Included for the first time in this indicator report is some data sourced from Tuatua Tika - Pacific Tobacco Control Report ASH Year 10 data and a summary of smokefree public places policies for the councils within the area covered by the CCN are again presented in this report, although there have been no updates. The New Zealand Tobacco Use Survey is not large enough to enable analysis of data by DHB so is not included in this report. Targets Hospitalised smokers: The national health target for better help for smokers to quit is: 80 percent of hospitalised smokers will be provided with advice and help to quit by July 2010; 90 percent by July 2011; and 95 percent by July All CCN DHBs set the same target for hospitalised smokers for 2010 and 2011 in their 2009/10 and 2010/11 District Annual Plans (DAPs) respectively. Primary care All CCN DHBs, in their 2010/11 DAPS set the target that 80 percent of patients attending primary care will be provided with advice and help to quit by July CANCER CONTROL INDICATORS - CENTRAL CANCER NETWORK : FEBRUARY

19 Percentage of pateints offered advice to quit smoking PREVENTION: Tobacco control Primary care Better help to quit Although data is not yet publically available, the better help for smokers to quit target has been extended to primary care and will be reported via the PHO Performance Programme (PPP). On 1 January 2010, two smoking indicators were introduced to the PPP indicator set. These were: i) percentage of eligible population who have ever had a smoking status recorded, and ii) percentage of eligible population whose most recent smoking status is recorded as current smoker. A further two indicators were introduced on 1 July These were: iii) percentage of current smokers who have been given brief advice in the last 12 months, and iv) percentage of current smokers who have been given or referred to cessation support services in the last 12 months. At such time as this data becomes publically available (indications are that this may be October/November 2011) it will be included in this report. Analysis - Hospitalised smokers, better help to quit Figure 4: Percentage of hospitalised smokers provided with advice and help to quit by CCN DHBs, Q3 2009/10 to Q2 2010/ C&C HB HV MC TAI TAR WAI WHA DHB Q3 2009/10 Q4 2009/10 Q1 2010/11 Q2 2010/11 July 2010 target July 2011 target At the time of writing this report, the Quarter 2, 2010/11 result for Wairarapa DHB had not been finalised, due to a backlog of coding for December In quarter two, 2010/11 five of the region s DHBs continued to make positive gains against the percentage of identified hospitalised smokers who are offered help and advice to quit smoking. As of this quarter, both and Hawke s Bay were above the 80% target for July 2010 and heading towards the July 2011 target of 90%. Wairarapa has consistently had results above 80%, but results for quarter two were not available at the time of writing this report due to a backlog of coding for December The 20% gain achieved by DHB this quarter was the largest across all DHBs nationwide. Two CCN DHBs saw a decrease in achievement in quarter two, and both are working towards improving performance for quarter three. CANCER CONTROL INDICATORS - CENTRAL CANCER NETWORK : FEBRUARY

20 Smoking prevalence (%) Percentage of pateints offered advice to quit smoking PREVENTION: Tobacco control Figure 5: Percentage of hospitalised smokers provided with advice and help to quit by ethnicity, CCN DHBs, Q2 2010/ C&C HB HV MC TAI TAR WAI WHA DHB Māori Pacific Peoples Total population Wairarapa data is for Quarter 1, 2010/11 because at the time of writing this report Quarter 2 data had not been finalised, due to a backlog of coding for December No data reported for Pacific Peoples by and Wairarapa. Better help to quit data by ethnicity shows that for four CCN DHBs, the percentage of identified hospitalised smokers offered help and advice to quit is higher for Māori than for all patients (by between 1% and 16%). For the four DHBs where the result for Māori is lower, the difference ranges from 2% to 4%. Six DHBs reported a result for Pacific Peoples and for all but two of these, the result for Pacific Peoples was higher than that for the total population (ranging from 1% to 13%). For the two DHBs with a lower result for Pacific Peoples, this was by 5% and 6%. Analysis - Smoking prevalence Table 7: Smoking prevalence by CCN DHB, New Zealand Health Survey 2006/07 and Census 2006 Current daily smoker* Current smoker** Regular smoker*** C&C HB HV MC TAI TAR WAI WHA NZ * A current daily smoker is defined as a person who smokes one or more cigarettes per day. Crude rate, from NZHS 2006/07. ** A current smoker, based on the World Health Organization definition, is someone who has smoked more than 100 cigarettes in their lifetime and is currently smoking at least once a month. Crude rate, from NZHS 2006/07. ***A regular smoker as per the 2006 census is defined as someone who smokes cigarettes regularly, i.e. one or more cigarettes a day. Figure 6: Smoking prevalence for hospitalised patients, by ethnicity, CCN DHBs, Q2 2010/ C&C HB HV MC TAI TAR WAI WHA DHB Māori Pacific Peoples Total population Wairarapa data is for Quarter 1, 2010/11 because at the time of writing this report Quarter 2 data had not been finalised, due to a backlog of coding for December 2010 No data reported for Māori by DHB. No data reported for Pacific Peoples by, and Wairarapa DHBs. CANCER CONTROL INDICATORS - CENTRAL CANCER NETWORK : FEBRUARY

21 PREVENTION: Tobacco control A comparison of smoking prevalence for hospitalised patients with smoking prevalence obtained via the New Zealand Health Survey and 2006 census shows that results for hospitalised patients are lower for many CCN DHBs. While a genuine reduction in smoking prevalence could potentially account for some of this decrease a larger factor may be that not all hospitalised smokers are being identified. For some DHBs this may also be influenced by the higher proportion of Europeans aged over 65 years in the hospitalised group (who tend to have a lower smoking prevalence). Despite lower than expected prevalence when compared with the health survey and census data, smoking prevalence for hospitalised smokers by ethnicity still clearly shows a higher prevalence of smoking amongst Māori than that for the total population in all DHBs. Where prevalence for Pacific Peoples was reported (five DHBs), all showed a slightly higher smoking prevalence for Pacific Peoples when compared to the total population. Analysis Tuatua Tika, Pacific Tobacco Control The Tuatua Tika Report (Straight talk about Pacific Peoples and smoking) has been developed to ensure that Pacific communities, health professionals working with Pacific Peoples and the tobacco control sector have access to appropriate, relevant and up-to-date Pacific tobacco control information 2. Table 8: Regular smoking prevalence (non age-standardised) by Pacific ethnic group, 2006 census* Pacific ethnic group Female Male Total % # % # % # Tokelauan 40% % % 1,533 Cook Islands Māori 36% 6,432 34% 5,553 35% 11,985 Niuean 30% 2,133 31% 2,007 31% 4,137 Tongan 19% 2,772 35% 5,082 27% 7,851 Samoan 23% 9,816 29% 11,124 26% 20,940 Other Pacific Peoples 19% % % 1,071 Fijian 18% % % 1,275 Total Pacific Peoples 25% 21,666 31% 24,504 28% 46,170 *Statistics New Zealand defines regular smokers as someone who currently smokes one or more manufactured or hand rolled tobacco cigarettes per day. The Tuatua Tika Report states Almost half of all Pacific smokers were Samoan (21,000), with Cook Islands Māori (12,000), and Tongan (8,000) also accounting for a large proportion of the total Pacific smoking population, reflecting their large populations. Despite relatively low smoking prevalence among Samoan and Tongans compared to other Pacific groups, the size of their respective populations in New Zealand means these groups make up a significant proportion of Pacific smokers, alongside Cook Islands smokers. Although smoking prevalence is particularly high among Tokelauans, the actual number of Tokelauan smokers is much smaller than the number of Samoan, Cook Islands and Tongan smokers. 2 Tuatua Tika, Straight talk about Pacific Peoples and Smoking, Pacific Tobacco Control Report, Tala Pasifika, National Pacific Tobacco Control Service, Pacific Heartbeat, Heart Foundation. August CANCER CONTROL INDICATORS - CENTRAL CANCER NETWORK : FEBRUARY

22 PREVENTION: Tobacco control Table 9: Estimated percentage and number of current Pacific smokers, by CCN DHB, New Zealand Health Survey, * (age-standardised) DHB Percentage of Pacific Peoples who smoke Estimated number of Pacific Peoples who smoke Percentage of all Pacific Peoples who smoke in NZ Percentage of all Pacific Peoples who smoke in CCN region C&C 20% 4,397 6% 34% HB 38% 1,991 3% 15% HV 28% 3,290 4% 25% MC 31% 1,436 2% 11% TAI 45% 583 1% 5% TAR 32% 432 1% 3% WAI 32% 268 0% 2% WHA 40% 548 1% 4% NZ 30% 78,674 *The New Zealand Health Survey used the World Health Organisation definition for a current smoker which is someone who has smoked more than 100 cigarettes in their lifetime and is currently smoking at least once a month. Please note that results differ slightly between Table 8 and Table 9 due to different definitions of smoking, different time frames and age standardisation. The last two columns in Table 9 and Table 10 were calculated specifically for this report and are not presented in The Tuatua Tika Report. While smoking prevalence for Pacific Peoples is highest in and DHBs, smokers in these two DHBs represent less than 10% of all Pacific smokers in the CCN region. Capital & Coast has the lowest prevalence of smoking for Pacific Peoples in the region, but the highest population meaning that a third of all Pacific smokers in the region reside in this DHB. Only two CCN DHBs have a smoking prevalence for Pacific Peoples which is less than the average for New Zealand (not tested for statistical significance). Table 10: Estimated percentage and number of Pacific non-smokers exposed to second-hand smoke, by CCN DHB, (age-standardised) DHB Percentage of Pacific non smokers exposed to second hand smoke Estimated number of Pacific non smokers exposed to second hand smoke Percentage of all Pacific non smokers exposed to second hand smoke in NZ Percentage of all Pacific non smokers exposed to second hand smoke in CCN region C&C 16% 3,516 7% 41% HB 20% 1,071 2% 12% HV 18% 2,082 4% 24% MC 20% 926 2% 11% TAI 23% 293 1% 3% TAR 21% 281 1% 3% WAI 20% 167 0% 2% WHA 22% 292 1% 3% NZ 18% 47,219 In only one CCN DHB is the percentage of Pacific non-smokers exposed to second hand smoke lower than that for New Zealand. Analysis Smoking prevalence Māori Table 11: Regular smoking prevalence for Māori, CCN DHBs, 2006 census C&C HB HV MC TAI TAR WAI WHA NZ Females Males Total Analysis - ASH Year 10 smokers The table below shows by year the proportion of Year 10 students who are daily or regular smokers or have never smoked for the years It is anticipated that 2010 data will be included in the August 2011 report. CANCER CONTROL INDICATORS - CENTRAL CANCER NETWORK : FEBRUARY

23 PREVENTION: Tobacco control Table 12: Trends in proportion of Year 10 students daily, regular (daily, weekly or monthly) smoking or never smoked from by CCN DHB DHB Type smoking result significantly Capital & Coast Hawke s Bay Wairarapa Daily Yes Regular Yes Never Yes Daily Yes Regular Yes Never Yes Daily Yes Regular Yes Never Yes Daily Yes Regular Yes Never Yes Daily No Regular No Never Yes Daily No Regular Yes Never Yes Daily Yes Regular Yes Never Yes Daily Yes Regular Yes Never Yes different to 2005 ASH Year 10 survey data by CCN DHB for the years 1999 to 2009 shows that smoking prevalence is decreasing for this age group (14-15 years). The 2009 survey shows that the odds of never smoking a cigarette have significantly increased in 2009 compared to 2005 for all CCN DHBs (adjusting for age, sex and ethnicity). For the same years, the odds of smoking have significantly decreased in all CCN DHBs with the exception of (both daily and regular) and (daily). CANCER CONTROL INDICATORS - CENTRAL CANCER NETWORK : FEBRUARY

24 PREVENTION: Tobacco control Analysis - Smokefree outdoor public places policies by local authority Table 13: Smokefree outdoor public places policies for the 24 local authorities within the CCN region Local authority Smokefree areas Date resolved/approved Implementation launch date Gisborne District Council Council-run and sponsored events, patrolled beaches and council lands and reserves during children's sports and activities. Nov 2005 During 2006 Wairoa District Council All council-owned sports fields, playgrounds and open-spaced reserves. Jun 2007 May 2008 Hastings District Council All parks, playgrounds and sports grounds. Jun 2007 May 2008 Napier City Council All playgrounds and sports grounds. Jul 2008 During 2009 Central Hawke's Bay District Council All playgrounds and sports grounds. Jun 2007 May 2008 Chatham Islands Territory Council All playgrounds and sports grounds. Aug 2008 Oct2008 New Plymouth District Council All council-owned parks, playgrounds, sports grounds and walkways. Aug 2007 Aug 2007 Stratford District Council All council owned enclosed public facilities (e.g. halls), swimming pools and outdoor surrounds, playgrounds and parks. Sep2007 Sep2007 South District Council All Council owned swimming pools and outdoor surrounds, playgrounds and parks. May 2005 Aug 2005 Ruapehu District Council No policy and no plans at present. N/A N/A Wanganui District Council All playgrounds, sports fields and open reserves. Nov2006 May 2007 Rangitikei District Council No smokefree public places policy at the moment although signage is displayed at children s play parks across the district declaring them to be smokefree at the request of DHB (who provided the signage). N/A N/A Tararua District Council Swimming pools (inside and outside), council-owned public spaces (e.g. halls), parks, sports grounds and playgrounds. Mar 2008 Sep 2008 Palmerston North City Council All playgrounds and sports fields Horowhenua District Council Playgrounds, sports fields, parks and reserves (note this is an initiative not a policy). Not obtained Not obtained Manawatu District Council No policy at present. DHB provided signs not put up. N/A N/A Kapiti Coast District Council All playgrounds and sports grounds. Sep2008 Dec2008 Porirua City Council All sports fields and playgrounds. Mar 2010 Jul 2010 onwards Wellington City Council Smoking banned in Cable Car Lane and enclosed areas e.g. swimming pools and Westpac stadium. Trialling a smoke and 2004 (Cable Car alcohol free policy on new artificial sport turfs, with a view to consider an extension to all sports fields in the future. Lane) Masterton District Council Minimisation of smoking at playgrounds and skate parks, sports fields and sports facilities, swimming pools and recreation centre stadium. May 2009 May 2009 Carterton District Council Parks and playgrounds. Sep 2007 Council owned enclosed public facilities (e.g. halls, libraries, service centres), swimming pools, shelters and like facilities at South Wairarapa District transfer stations, public toilets, playgrounds, Card Reserve Stadium and any other facility considered to be controlled by Council the Council. Jul 2007 Jul 2007 Upper Hutt City Council All parks, reserves, playgrounds and sports fields. Feb 2006 May 2006 Hutt City Council All playgrounds and swimming pools and their surrounding areas. Oct 2009 Information sourced from the Smokefree Councils website ( and via direct correspondence with those councils not on the website. N/A = not applicable. In May 2005, South District Council led the way by adopting the country s first Smokefree Environments Policy. When New Plymouth and Stratford followed suit in August 2007, became the first smokefree district in New Zealand. Within the CCN region, most other local authorities (21/24, 88%) now also have smokefree public places policies. However a few are still to really progress this area (Manawatu, Ruapehu and Rangitikei). CANCER CONTROL INDICATORS - CENTRAL CANCER NETWORK : FEBRUARY