Northern Oesophago-Gastric Cancer Unit MDT meeting NECN Audit day 2012

Transcription

1 Northern Oesophago-Gastric Cancer Unit MDT meeting NECN Audit day 2012 Helen Jaretzke, Angie Tate, Jon Shenfine, Paula Brookes, Leigh-Anne Phillips, Gillian Robinson, Jonathan Stoddart

2 Methods Patients discussed at Friday Newcastle Multi-disciplinary Team meeting (MDT) January 2011 December 2011 Excludes: Patients discussed by video-link to Sunderland only Prospective data entry onto database - Dendrite Intended use: Local, Regional & National audit Research Data then exported onto Microsoft Excel for analysis

3 National Audit: Recommendations

4 Units Contributing to NOGCA Number of Patients Lancashire and South Cumbria 458 Greater Manchester and Cheshire 1,044 Merseyside and Cheshire 681 Yorkshire 424 Humber and Yorkshire Coast 169 North Trent 706 Pan Birmingham 360 Arden 237 Mid Trent 724 Derby/Burton 286 Leics, Northants and Rutland 577 Mount Vernon 232 West London 289 North London 88 North East London 476 South East London 265 South West London 227 Peninsula 636 Dorset 267 Avon, Somerset and Wiltshire Counties 534 Thames Valley 487 Central South Coast 684 Surrey, West Sussex and Hampshire 211 Sussex 310 Kent and Medway 430 Greater West Midlands 505 North of England 1,252 Anglia 896 Essex 199

5 Units Contributing to NOGCA Number of Patients Lancashire and South Cumbria 458 Greater Manchester and Cheshire 1,044 Merseyside and Cheshire 681 Yorkshire 424 Humber and Yorkshire Coast 169 North Trent 706 Pan Birmingham 360 Arden 237 Mid Trent 724 Derby/Burton 286 Leics, Northants and Rutland 577 Mount Vernon 232 West London 289 North London 88 North East London 476 South East London 265 South West London 227 Peninsula 636 Dorset 267 Avon, Somerset and Wiltshire Counties 534 Thames Valley 487 Central South Coast 684 Surrey, West Sussex and Hampshire 211 Sussex 310 Kent and Medway 430 Greater West Midlands 505 North of England 1,252 Anglia 896 Essex 199

6 North of England County Durham and Darlington NHS Foundation Trust North Cumbria Acute Hospitals NHS Trust North Tees and Hartlepool NHS Trust Northumbria Healthcare NHS Foundation Trust South Tees Hospitals NHS Foundation Trust The Newcastle upon Tyne Hospitals NHS Foundation Trust

7 Discussions: Central Newcastle MDT 0% 20% 40% 60% 80% 100% Total excl Carlisle New Rediscussions n=1444 incl Carlisle - 87

8 New discussions 0% 20% 40% 60% 80% 100% Total OG Neoplasm Benign Carlisle Other Other incl. Gists, HGD, LGD, Surveillance pts, Barrett s surveillance pts, referred onto another MDT n=597 + ca 522

9 New OG neoplasm 0% 20% 40% 60% 80% 100% Total New Staging In-Patients Restage n=437

10 Number of New MDT Discussions No. of Discussions >6 N=437 Excl. Carlisle pts

11 Comparison multiple discussions % 20% 40% 60% 80% 100% >6 Excl. Carlisle pts

12 Carlisle Discussions 2011 Carlisle Patients (Total 87) Discussed in MDM No. of Patients >5 No. of Times Each Patient Discussed in MDT

13 Newcastle Northumb'd Sunderland Durham S. Tyneside Gateshead Others Unclass'd New referrals to MDT by site n=450 vs. 324 vs. 408 vs 467 vs excl Carlisle pts positive cancers only

14 Intention to treat by site Total Sunderland South Tyneside Gateshead NUTH Northumberland Durham 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Friday MDT s only Curative Palliative No action No action incl. Best supportive care & referral onto other MDT s

15 Oesophageal Cancer: (2011) Histological subtype Histology 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% ACA SCC Small Cell HGD Other Other incl. Carcinoid, Leioyoma

16 Oesophageal Cancer: Treatment intent by histological subtype SCC ACA 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Curative Palliative

17 Oesophageal cancer: Curative treatment intent ACA SCC Other 0 NA+Sx Sx Alone RT CRT R & Sx EMR

18 Resections Oesophagectomy Gastrectomy

19 Resections breakdown STO 3 Stage Lap + Thoracotomy TG STG Wedge/Partial Gast/Sleeve Gast Lap only O&C unplanned

20 Morbidity 0% 20% 40% 60% 80% 100% No Complications Complications Mortality n= n= n= n=

21 Mortality surgery % 20% 40% 60% 80% 100% Oesophagectomy 76 0 Gastrectomy 69 0 Surgery Mortality Please note: above figs are actual. Open and close are not included

22 Pathological Stage by subtype Tis HGD T0N1 T1N0 T1N1 T1N2 T2N0 T2N1 T3N0 T3N1 T3N2 T2N2 T4N0 T3N3 T4N1 T4N2 T4N3 ACA SCC Excl. Carcinoid s & Leioyoma s excluded, 8 open and close excluded

23 Oesophageal Cancer: Treatment change Intended Treatment Treatment Change n Neoadjuvant + Surgery Unfit for surgery 1 Neoadjuvant + Surgery Progression of disease, no surgery 4 Neoadjuvant + Surgery RIP (1 cycle) 0 Neoadjuvant + Surgery Moved to clinical trial 0 Neoadjuvant + Surgery Shortened chemotherapy due to toxicity 5 Magic + surgery No post-op chemo given due to chest pain 0 Neoadjuvant + Surgery Low GFR, no neoadjuvant given 2 Neoadjuvant + Surgery Patient declined 1 Surgery Not fit for surgery/patient declined 2 Chemoradiotherapy Not fit for CRT 1

24 Recruitment to trials % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% OE05 ST03 COUGAR-02 REAL3 Fail Recruited

25 UGI Two Week Waits Jan Feb March April May June July August September October November December 2ww 31 day treats 62 day treats 62 day breaches

26 2 Week Waits - Comparison WW

27 Breaches - Comparison Breaches

28 Issues? Re-haul of database Now gives us what we need Much more accurate Complications data much improved Now introduced Clavien-Dindo/Accordian Robust weekly system for collection of data on complications

29 Why complicate things