National Oesophago-Gastric Cancer Audit New Patient Registration sheet Patients with Oesophageal High Grade Glandular Dysplasia

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1 National Oesophago-Gastric Cancer Audit New Patient Registration sheet Patients with Oesophageal High Grade Glandular Dysplasia Patient Details Surname: NHS number: Forename: Postcode: Sex: Male Female Not specified Not known Date of birth: Initial Referral to Local Oesophago-gastric Team and Diagnostic Process Source of referral From surveillance service: Symptomatic referral Not known Date of endoscopic biopsy in which HGD was first diagnosed: Hospital where the first endoscopic biopsy was taken: Was the original diagnosis of HGD confirmed by a second pathologist? Yes No Not known Was a repeat biopsy taken to confirm the diagnosis of HGD? Yes No Not known Did the repeat biopsy confirm the diagnosis of HGD? Yes No Not known Was the second biopsy diagnosis of HGD confirmed by a second pathologist? Yes No Not known Comorbidities? None Cardiovascular disease COPD / Asthma Chronic Renal Impairment Liver Failure / Cirrhosis Diabetes Mental Illness Cerebro / peripheral vascular disease Significant other Endoscopic Report At the initial endoscopy where a diagnosis of HGD was made: - Were quadrantic biopsies taken every 2cm from the entire segment of Barrett s? Yes No Not known - Were additional biopsies taken of any visible nodule? Yes No Not known HGD appearance Flat mucosa Nodular lesion Depressed lesion Not known 1 Barrett s Se gm ent Present Absent Not known 1

2 Endoscopic Report (Continued) Leng th of Barrett s Segm en t Is the length of circumferential columnar lining recorded in the endoscopy report? Yes Length of Circumferential Columnar Lining (nearest 0.5 cm): No C. cm Is the maximum length of columnar lining recorded in the endoscopy report? Yes Maximum length including tongues/islands of Columnar Lining (nearest 0.5 cm): No M. cm HGD Lesion (based on pathology report) Unifocal Multi-focal Not known Planned Treatment Hospital at which treatment plan made Date treatment plan agreed Was the treatment plan agreed at an MDT meeting? Yes No Hospital where initial treatment was given Date initial treatment was given Initial treatment modality Surveillance (follow up endoscopy) Oesophagectomy Photo dynamic therapy Endoscopic Mucosal Resection (EMR) Endoscopic Submucosal Dissection (ESD) Other Radiofrequency ablation Argon plasma coagulation Multipolar electrocautery Laser therapy Cryotherapy No active treatment 2

3 Use of surveillance or no active treatment as planned treatment What was the reason for this treatment plan? Patient choice Patient unfit for endoscopic or surgical treatment Lack of access to endoscopic treatment or surgery Unknown Use of surveillance If plan was surveillance, when was the next surveillance endoscopy planned for? 3 months 4-6 months 7-12 months >12 months Not known 3

4 Use of Endoscopic Mucosal Resection (EMR) / Endoscopic Submucosal Dissection (ESD) Date of EMR/ESD: Was excision complete? Yes No Not Known If yes, what was the ongoing plan? Further endoscopic treatment of the remaining Barrett s segment Surveillance (follow up endoscopy) only No further surveillance or treatment Not Known If no, what was the ongoing plan? Further EMR/ESD Further ablative endoscopic treatment e.g. RFA, APC Refer for oesophagectomy Surveillance (follow up endoscopy) only No further surveillance or treatment Not Known Post-treatment Histology (pathology results based on EMR/ESD) No high-grade dysplasia or carcinoma High-grade dysplasia confirmed Intramucosal carcinoma identified Submucosal carcinoma or worse 4

5 National Oesophago-Gastric Cancer Audit New Patient Registration datasheet Patients with Oesophageal Gastric Cancer Patient Details Surname: NHS number: Forename: Postcode: Sex: Male Female Not specified Date of birth: Initial Referral and Diagnosis Data Source of referral: Direct from GP Barrett s Surveillance Emergency admission Open access endoscopy Other initiated by consultant (outpatient episode) Not known Priority of referral: Urgent 2-week wait Routine referral (GP referral only) Date of first referral to local oesophago-gastric team for investigation: Date of diagnosis: Local cancer unit where cancer was diagnosed: Diagnosis - Site Oesophagus: Upper 1 / 3 Middle 1 / 3 Lower 1 / NB: cervical oesophageal tumours 3 are NOT included in this audit Gastro-Oesophageal Junction (adenocarcinomas only) Siewert classification: Stomach: Fundus Body Antrum Pylorus Diagnosis - Histology Invasive adenocarcinoma Adenosquamous carcinoma Undifferentiated carcinoma Squamous cell carcinoma Small-cell carcinoma Other epithelial carcinoma NB: Non-epithelial tumours (GIST, sarcomas or melanomas) are NOT included in this audit Staging investigations (please tick all that apply) None CT scan Endoscopic ultrasound (EUS) Staging laparoscopy PET / PET CT scan EUS Fine needle aspiration Other investigation 5

6 Pre Treatment Stage Which TNM version do you use: TNM v6 TNM v7 TNM v8 T: 0 Tis 1 1a 1b 2 2a 2b 3 4 4a 4b x N: a 3b x M: 0 1 x ECOG (WHO) Performance Status 0 Carries out all normal activity without restriction 3 Limited self care, confined to bed or chair for >50% waking hours 1 Restricted but walks/does light work 4 Fully disabled, confined to bed/chair 2 Walks, full self care but no work. Up and about >50% of the time Comorbidities (please tick all that apply) None Cardiovascular disease Chronic renal impairment Cerebro/periph vascular Other significant condition Liver failure or cirrhosis Diabetes Barrett s oesophagus Mental illness Chronic respiratory disease (including COPD/asthma) Treatment Plan Date final care plan agreed: Treatment intent: Curative: Non-curative (palliative) No active treatment (supportive care) (ie. surgery, chemotherapy, radiotherapy, endoscopy) (ie. non -specific symptomatic treatments) Details of planned treatment Curative modality Surgery only Chemotherapy and surgery (any combination) Chemo-radiotherapy and surgery (any combination) (Definitive) Radiotherapy only Definitive chemo - radiotherapy Endoscopic mucosal resection Palliative modality Palliative surgery Palliative oncology (unspecified) Endoscopic palliation therapy No active treatment (supportive care) 6

7 Reasons for palliative treatment (please tick all that apply) Patient declined treatment Unfit, because of advanced stage cancer Unfit, because significant co-morbidity Unfit, because poor performance status Not known 7

8 National Oesophago-Gastric Cancer Audit Postoperative Datasheet (Oesophageal Gastric Cancer and HGD Patients) Patient details (for patient identification only) Surname NHS number Forename Date of birth Admission and Surgical Details (Main procedure only) Hospital name: Date of admission: Date of operation: Pre-operative intent of surgery: Palliative Curative Fitness for Surgery (ASA grade): Smoking: current smoker ex-smoker non-smoker (history unknown) never smoked not known Procedure Oesophageal Gastric - Oesophagectomy: - Gastrectomy: Left thoraco-abdominal approach Total Extended total 2 Phase (Ivor-Lewis) Proximal Distal 3 Phase (McKeown) Completion Merendino Transhiatal Wedge/localised gastric resection Bypass procedure / Jejunostomy only Thoracotomy (Open & Shut) Laparotomy (Open and Shut) Number of Surgeons involved in the original operation: GMC Code for Surgeon Responsible for original operation: GMC Code for additional Surgeon 1 involved in original operation: GMC Code for additional Surgeon 2 involved in original operation: GMC Code for additional Surgeon 3 involved in original operation: 8

9 Surgical Access (thoracic) the approach used for the thoracic phase of the operation (if applicable) Open operation Thoracoscopic converted to open Thoracoscopic completed Not applicable Surgical Access (abdominal) the approach used for the thoracic phase of the operation Open operation Nodal Dissection Laparoscopic converted to open Laparoscopic completed Oesophagectomy: None 1 field 2 field 3 field Gastrectomy: D0 (peri-gut resection) D1 D2 D3 Postoperative complications and course (please tick all that apply) None Respiratory: Anastomotic leak Chyle leak Haemorrhage Cardiac complication Acute renal failure Other Pneumonia ARDS Pulmonary embolism Pleural effusion Wound infection Unplanned return to theatre? Yes No Death in hospital? Yes No Date of discharge or death: N Postoperative pathology and staging Site of tumour: Oesophagus: Upper 1 / 3 Middle 1 / 3 Lower 1 / 3 NB: cervical oesophageal tumours are NOT included in this audit Gastro-Oesophageal Junction (adenocarcinomas only) Siewert classification: Stomach: Fundus Body Antrum Pylorus Histology: Invasive Adenocarcinoma Adenosquamous carcinoma Undifferentiated carcinoma Malignant Neoplasm Squamous cell carcinoma Small-cell carcinoma Other epithelial carcinoma Complete regression 9

10 Proximal resection margin involved? Yes No Distal resection margin involved? Yes No Circumferential resection margin involved? (<1mm) Yes No N/A Number of lymph nodes examined: Number of lymph nodes positive: Postoperative stage Which TNM version do you use: TNM v6 TNM v7 TNM v8 T: 0 Tis 1 1a 1b 2 2a 2b 3 4 4a 4b x N: a 3b x M: 0 1 x Patient had neoadjuvant therapy prior to surgery: Yes No Enhanced recovery after surgery (ERAS) What best describes the surgical pathway that this patient followed? A protocolised enhanced recovery (ERAS) without daily documentation in medical notes? A protocolised enhanced recovery (ERAS) with daily-documentation in medical notes? A standard (non-eras) surgical pathway Did the patient complete the ERAS pathway? Yes No: but partial completion No: non-completion Unknown / not documented 10

11 National Oesophago-Gastric Cancer Audit Chemotherapy/Radiotherapy Datasheet (Oesophageal Gastric Cancer Patients) Please fill in this datasheet for every course of oncological treatment received by a patient with oesophagogastric cancer. Most patients will only require one datasheet to be completed. For patients who have both neoadjuvant and adjuvant therapy, complete two separate datasheets. Patient details (for patient identification only) Surname NHS number Forename Date of birth Hospital of treatment Hospital where oncology treatment took place Treatment details Treatment intent: Neoadjuvant Adjuvant Curative Palliative Intended treatment modality: Chemotherapy Radiotherapy Chemo-radiotherapy Details of therapy Chemotherapy details (if applicable) Radiotherapy details (if applicable) Date first cycle started: Date first fraction started: Outcome of treatment: Treatment completed as prescribed Outcome of treatment: Treatment completed as prescribed Reason if incomplete Patient died Progressive disease during treatment Acute chemotherapy toxicity Technical or organisational problems Patient choice (interrupted or stopped treatment) On-going treatment Reason if incomplete Patient died Progressive disease during treatment Acute radiotherapy toxicity Technical or organisational problems Patient choice (interrupted or stopped treatment) Not known Not known Post oncology fitness (for neoadjuvant therapy only) Patient proceeded to planned curative surgery: Yes No Not applicable 11

12 National Oesophago-Gastric Cancer Audit Endoscopic / Radiological Palliative Therapy Datasheet (Oesophageal Gastric Cancer Patients) Please fill in this datasheet for every patient with oesophago-gastric cancer on the occasion of their FIRST PALLIATIVE endoscopic / radiological therapeutic intervention. Patient details (for patient identification only) Surname NHS number Forename Date of birth Treatment details Hospital name: Date of endoscopic / radiological procedure: Procedure details Type of procedure (tick all that apply) Insertion of stent Laser therapy Argon plasma coagulation Photodynamic therapy Gastrostomy Brachytherapy Dilatation (Tick dilatation if it was the only procedure or if required to facilitate treatment) Other Is this procedure part of a planned course of multiple interventions? Yes No Not known Anaesthesia: Sedation Local anaesthetic spray General anaesthesia Sedation and local anaesthetic spray combined Not known Details of stent procedure, if inserted Type of stent: Plastic: expandable Metal: covered Metal: Anti-reflux Not known Biodegradable Metal: uncovered Other Method of stent placement: Fluoroscopic control Endoscopic control Fluoroscopic & Endoscopic Not known Immediate complications following stent insertion (tick all that apply) No complication Postoperative stricture Perforation Haemorrhage Other complications 12

13 VERSION HISTORY Version Date created Version description Author /12/2011 First draft based on First NOGCA O Groene / D Cromwell /12/2011 Revision after review/comparison with COSD O Groene / D Cromwell /01/2012 Integration of full data set O Groene / D Cromwell /02/2012 Review O Groene / D Cromwell /11/2012 Revision in line with new data collection system /04/2013 Amendment to Pre-treatment Histology /05/2013 Addition of surgeon level data items /08/2015 Updated HGD data items /09/2016 Content review and formatting C Brand /03/2017 Added ERAS items C Brand /01/2018 Added TNM 8 and content revision C Brand 13