NHS. Northern and Yorkshire Cancer Registry and Information Service

Transcription

1 NHS Northern and Yorkshire Cancer Registry and Information Service Northern and Yorkshire Cancer Networks A Report on Incidence and Management for the Main Sites of Cancer

2 ACKNOWLEDGEMENTS Acknowledgements Once again staff have worked together to produce a region-wide report covering four cancer networks - the second such report to be produced by. We have sought to retain the most informative analyses from our last report whilst exploring new ways of analysing and presenting cancer registry data. This is a reflection of the high quality data collected by and has required much commitment from our staff. would like to thank its many colleagues in the cancer networks for their co-operation and help in producing this report. We hope that this collaboration also helps to promote increased understanding of cancer data and related issues to a wider audience. We would also like to thank the Northern and Yorkshire Public Health Observatory for providing the resource and expertise to produce the cancer network boundary map, which was also used in the 1998 Report. NHS Northern and Yorkshire Cancer Registry and Information Service, Arthington House, Hospital Lane, Leeds, LS16 6QB Tel: Fax: Correspondence should be directed to: Caroline Brook, Information Services Manager caroline.brook@nycris.leedsth.nhs.uk David Forman, Director of Information & Research david.forman@nycris.leedsth.nhs.uk Further copies of this report may be obtained from (address above) or electronically in PDF format from our website Copyright 2002, Extracts from this report may be reproduced provided the source is fully acknowledged within The Leeds Teaching Hospitals NHS Trust NHS

3 CONTENTS 2 Contents Foreword 1 Introduction Geography 2 Populations 2 Data Quality 3 Analyses 3 Section 1 Overview of major cancer sites 4 Section 2 Network management 11 Network management (Childhood cancers) 13 Network management (Waiting times) 14 Section 3 Common cancers 16 Colorectal 19 Lung 24 Breast 27 Section 4 Intermediate cancers 31 Upper gastro-intestinal 32 Gynaecological 35 Urological 40 Section 5 Registrations, incidence rates, deaths and mortality rates 45 Glossary of Terms and Definitions 55

4 1 FOREWORD Foreword This is the second report to be presented in a network-based format, providing statistics about cancer and cancer care using cancer networks as the main geographical unit for analysis. Last year s report was well-received and marked a notable milestone in presenting information of an equivalent data quality for the whole area. We are grateful for the range of helpful feedback about the content and presentation of the report which has been used to develop this publication. This report of cancer data builds on last year s work, and specifically offers more detailed information on cancers of intermediate frequency (gynaecological, upper gastrointestinal and urological malignancies). These are the cancer sites that most actively involve networks in planning developments in their services and in service reconfiguration. The choice of these sites follows the sequence of publication of the Improving Outcomes 1 guidance reports. There is a continuing demand for information to be published in a variety of formats. Traditional printed material gives the user a handy reference document, but inevitably means that the producer must be highly selective in the data included. We hope that what is presented here will be useful. Over and above the information in this report, additional information is published on the website (), allowing a more extensive set of tables and graphics to be examined. I would encourage users to access this web-based data as well as current and future releases of QuickData 2, as many straightforward information needs can be met in this way. Over and above these sources we hope that this document will prompt specific information requests for those analyses which are non-standard or more complex in scope. The release of all information is governed by an explicit data release policy, which again is available on our website. Cancer registries, like all organisations involved with health information, are concerned with the proper handling of identifiable information and data derived from patient records. Our policy sets out the types of information that can be released to different categories of user and any specific requirements or constraints that apply to a given type of request. is indebted to its Advisory Group, composed of members with varied expertise and backgrounds nominated from across the networks, for their help in framing this policy, and for ensuring that it remains relevant and up to date. The Advisory Group is chaired by Professor Hall from the Northern Cancer Network. As last year we very much welcome feedback on the content and format of this report and a reply form is enclosed. Bob Haward Medical Director 1 The first documents in this series are available on the Department of Health website Subsequent documents will be available on the NICE website 2 Copies of QuickData can be downloaded from the website or can be requested via the contact details inside the front cover of this report.

5 INTRODUCTION 2 2 Introduction Geography Over the last year many aspects of the NHS geography have changed. However, the one constant in the catchment area is that it continues to relate exactly to four cancer networks. The 14 health authorities which it covered have now been abolished and replaced with four and a bit strategic health authorities (SHAs) and 44 Primary Care Trusts (PCTs). The regional offices have been disbanded and the new regional government offices (RGOs) are being established. will cover only one whole RGO (North East) plus the greater or lesser parts of two others (Yorkshire and the Humber, North West). Therefore it now makes even more sense to report our analyses by cancer network, as it covers our whole population. We are conscious that this report does not provide PCT level information, but this is next on our agenda. This map shows how the new SHA boundaries relate to the cancer networks. For example, it illustrates that the Humber and Yorkshire Coast Cancer Network () is wholly contained within one SHA, whilst the Northern Cancer Network () relates to three. The cancer networks are referenced throughout this report using the following abbreviations. They are also colour-coded for easier identification. Cumbria & Lancashire Northumberland, Tyne & Wear County Durham & Tees Valley West Yorkshire North & East Yorkshire & Northern Linconshire Cancer Care Alliance of Teesside, South Durham and North Yorkshire Humber and Yorkshire Coast Cancer Network Northern Cancer Network Yorkshire Cancer Network Represents all networks combined, i.e. the whole population Populations The estimated population of the area decreased slightly between 1998 and by 3,905. The mid-year population estimates are produced annually by ONS. Population estimates are not currently produced for cancer networks, therefore, they have to be derived from other estimates available. The methodology used for calculating the estimates for cancer networks is available on our website and is consistent with the estimates for the 1998 report. These population pyramids highlight the differences in the population profiles between the four cancer networks. Population pyramids for Northern and Yorkshire cancer networks (based on mid- estimates) Population 6,643,723 1,035,178 Age Group Population (in thousands) Females 527,352 2,011,898 Age Group Population (in thousands) Females 1,025,964 Males 507,826 Males 985,934 1,013,018 Age Group Population (in thousands) Females 514,048 2,583,629 Age Group Population (in thousands) Females 1,308,530 Males 498,970 Males 1,275,099

6 3 INTRODUCTION Data Quality Following a series of in-house quality assurance exercises, a snapshot of the registrations was taken in April A repeat snapshot of 1998 registrations was also taken in order to produce the comparative analyses. This accounts for any variations between the 1998 figures contained in this report and those published last year. This table contains key facts relating to the dataset used in this report. data (snapshot taken April 2002) % Complete (average of last 3 complete years) 105.8% Total Registrations () Malignant Benign/In-situ 7699 Number of Patients () Total Registrations (Extra-Regional) Malignant Benign/In-situ 68 Number of Patients (Extra-Regional) 538 Number of Death Certificate Only (DCO) cases 634 DCO rate (% of all registrations) 1.4% Analyses This report contains a range of analyses relating to both the service provision and epidemiology of cancer. It has given the opportunity to use two years of comparable regional data and, for the first time, produce some outcome measures relating to short term survival based on both 1998 and cases, as well as 30 day peri-operative mortality rates. All of these are comparable across cancer networks. The report aims to provide an overview of all cancers across the four networks, including more detailed analyses on the most common cancers (colorectal, lung, breast) and some of the less frequently occurring cancers (upper gastro-intestinal, gynaecological, urological). These less common cancers are referred to as intermediate cancers for the purposes of this report. Every effort has been made to present the analyses in the most intuitive way to promote interpretation and understanding of the data, including the colour-coding of the networks. Confidence limits have been quoted where relevant and are important considerations in the interpretation of small numbers. The report is divided into five sections, each containing a general introduction and a number of analyses with accompanying comments. KEY POINTS For quick reference, the key points relating to each section are contained within one of these boxes at the beginning of the section. A Glossary of Terms and Definitions is included at the end of the report and a number of appendices are available on the website, accompanied by a copy of this report in PDF format.

7 SECTION 1 >> OVERVIEW OF MAJOR CANCER SITES 4 1 This section provides an overview of incidence and mortality rates by network of residence and for as a whole, for all malignancies (including and excluding non-melanoma skin) for (Fig 1.3). Both the crude and age-standardised incidence rates are included in the tables in order to produce a local picture of incidence for the area, as well as providing a means of comparison against other networks and national figures. The overall age-standardised incidence rate in is per 100,000. As in 1998, both and have significantly higher incidence rates than and (Fig 1.1). Age-standardised mortality rates have significantly decreased between 1998 and in and for overall (Fig1.2). This trend begins to address the national target to reduce mortality rates by at least 20% by It will be important to monitor this closely over the coming years. These overall figures are followed by site-specific summaries for the major cancer sites (in ICD-10 code order) (Fig 1.4). These provide incidence and mortality rates by cancer network of residence and also include details regarding treatment modalities used for each of the sites, e.g. the percentage of those cases receiving surgery or radiotherapy. Finally these summaries list the number of new cases diagnosed and treated in a specific network regardless of where the patients lived. Site-specific variations between networks are harder to distinguish due to the smaller numbers of cases for each site. However, the tables do highlight some differences between incidence/mortality rates and also in management. For example, the incidence rate for lung cancer in remains significantly higher in and than in the other two networks and the age-standardised incidence rate for prostate cancer is significantly higher in than in the other networks and the region as a whole. In relation to management, there is a 7% variation in the percentage of patients receiving surgery for cancer of the stomach, 34% in compared with 41% in, and the proportion having no treatment for pancreas ranges between 71% in and 87% in. 1 NHS Cancer Plan, Department of Health, KEY POINTS The age-standardised incidence rate for was per 100,000 in compared with per 100,000 in and both had significantly higher incidence rates across all malignancies (excluding non-melanoma skin) than and in. There was a significant reduction in the mortality rate for the region between 1998 (210.9 per 100,000) and (203.4 per 100,000), with the most notable reduction in the male population of. In, the most common female cancer across the networks was breast (108.3 per 100,000) and for men it was lung (81.6 per 100,000). Female lung cancer incidence rates were significantly higher in and than in and in. 240 FIG 1.1 Females INCIDENCE MORTALITY Males FIG 1.2 MORTALITY (ASM) per 100, Age Standardised Incidence of All Malignancies (excl. non-mel skin) by Sex and Network in Age Standardised Mortality of All Malignancies (excl. non-mel skin) with 95% Confidence Limits in 1998 and SUMMARY ANALYSES INCIDENCE AND MORTALITY: ALL MALIGNANCIES F M ALL F M ALL F M ALL F M ALL F M ALL C00-97 ALL MALIGNANCIES Total Registrations Crude Incidence Incidence (ASR Europe) Incidence (95% LCL) Incidence (95% UCL) Total Deaths Crude Mortality Mortality (ASR Europe) Mortality (95% LCL) Mortality (95% UCL) FIG 1.3 C00-43, C45-97 Total Registrations Crude Incidence Incidence (ASR Europe) Incidence (95% LCL) Incidence (95% UCL) Total Deaths Crude Mortality Mortality (ASR Europe) Mortality (95% LCL) Mortality (95% UCL) ALL MALIGNANCIES EXCL. NON-MELANOMA SKIN

8 1 5 SECTION 1 >> OVERVIEW OF MAJOR CANCER SITES SUMMARY ANALYSES INCIDENCE, MORTALITY AND SPECIFIC ANALYSES IN : MAJOR CANCERS F M ALL F M ALL F M ALL F M ALL F M ALL C15 OESOPHAGUS Total Registrations Crude Incidence Incidence (ASR Europe) Incidence (95% LCL) Incidence (95% UCL) Total Deaths Crude Mortality Mortality (ASR Europe) Mortality (95% LCL) Mortality (95% UCL) % Surgery % Chemotherapy % Radiotherapy % No Treatment Diagnosed in Network Treated in Network C16 STOMACH Total Registrations Crude Incidence Incidence (ASR Europe) Incidence (95% LCL) Incidence (95% UCL) Total Deaths Crude Mortality Mortality (ASR Europe) Mortality (95% LCL) Mortality (95% UCL) % Surgery % Chemotherapy % Radiotherapy % Hormone Therapy % No Treatment Diagnosed in Network Treated in Network C18 COLON Total Registrations Crude Incidence Incidence (ASR Europe) Incidence (95% LCL) Incidence (95% UCL) Total Deaths Crude Mortality Mortality (ASR Europe) Mortality (95% LCL) Mortality (95% UCL) % Surgery % Chemotherapy % Radiotherapy % No Treatment Diagnosed in Network Treated in Network C19 RECTOSIGMOID JUNCTION FIG 1.4 Total Registrations Crude Incidence Incidence (ASR Europe) Incidence (95% LCL) Incidence (95% UCL) Total Deaths Crude Mortality Mortality (ASR Europe) Mortality (95% LCL) Mortality (95% UCL) % Surgery % Chemotherapy % Radiotherapy % No Treatment Diagnosed in Network Treated in Network

9 SECTION 1 >> OVERVIEW OF MAJOR CANCER SITES 6 1 SUMMARY ANALYSES INCIDENCE, MORTALITY AND SPECIFIC ANALYSES IN : MAJOR CANCERS F M ALL F M ALL F M ALL F M ALL F M ALL C20 RECTUM Total Registrations Crude Incidence Incidence (ASR Europe) Incidence (95% LCL) Incidence (95% UCL) Total Deaths Crude Mortality Mortality (ASR Europe) Mortality (95% LCL) Mortality (95% UCL) % Surgery % Chemotherapy % Radiotherapy % Hormone Therapy % No Treatment Diagnosed in Network Treated in Network C18-20 COLORECTAL Total Registrations Crude Incidence Incidence (ASR Europe) Incidence (95% LCL) Incidence (95% UCL) Total Deaths Crude Mortality Mortality (ASR Europe) Mortality (95% LCL) Mortality (95% UCL) % Surgery % Chemotherapy % Radiotherapy % Hormone Therapy % No Treatment Diagnosed in Network Treated in Network C25 PANCREAS Total Registrations Crude Incidence Incidence (ASR Europe) Incidence (95% LCL) Incidence (95% UCL) Total Deaths Crude Mortality Mortality (ASR Europe) Mortality (95% LCL) Mortality (95% UCL) % Surgery % Chemotherapy % Radiotherapy % Hormone Therapy % No Treatment Diagnosed in Network Treated in Network C32 LARYNX FIG 1.4 Total Registrations Crude Incidence Incidence (ASR Europe) Incidence (95% LCL) Incidence (95% UCL) Total Deaths Crude Mortality Mortality (ASR Europe) Mortality (95% LCL) Mortality (95% UCL) % Surgery % Chemotherapy % Radiotherapy % No Treatment Diagnosed in Network Treated in Network

10 1 7 SECTION 1 >> OVERVIEW OF MAJOR CANCER SITES SUMMARY ANALYSES INCIDENCE, MORTALITY AND SPECIFIC ANALYSES IN : MAJOR CANCERS F M ALL F M ALL F M ALL F M ALL F M ALL C33-34 LUNG Total Registrations Crude Incidence Incidence (ASR Europe) Incidence (95% LCL) Incidence (95% UCL) Total Deaths Crude Mortality Mortality (ASR Europe) Mortality (95% LCL) Mortality (95% UCL) % Surgery % Chemotherapy % Radiotherapy % No Treatment Diagnosed in Network Treated in Network C43 MELANOMA OF SKIN Total Registrations Crude Incidence Incidence (ASR Europe) Incidence (95% LCL) Incidence (95% UCL) Total Deaths Crude Mortality Mortality (ASR Europe) Mortality (95% LCL) Mortality (95% UCL) % Surgery % Chemotherapy % Radiotherapy % No Treatment Diagnosed in Network Treated in Network C44 SKIN (EXCL. MELANOMA) Total Registrations Crude Incidence Incidence (ASR Europe) Incidence (95% LCL) Incidence (95% UCL) Total Deaths Crude Mortality Mortality (ASR Europe) Mortality (95% LCL) Mortality (95% UCL) % Surgery % Chemotherapy % Radiotherapy % No Treatment Diagnosed in Network Treated in Network C44 SKIN (BCC) FIG 1.4 Total Registrations Crude Incidence Incidence (ASR Europe) Incidence (95% LCL) Incidence (95% UCL) % Surgery % Chemotherapy % Radiotherapy % No Treatment Diagnosed in Network Treated in Network

11 SECTION 1 >> OVERVIEW OF MAJOR CANCER SITES 8 1 SUMMARY ANALYSES INCIDENCE, MORTALITY AND SPECIFIC ANALYSES IN : MAJOR CANCERS F M ALL F M ALL F M ALL F M ALL F M ALL C44 SKIN (SCC) Total Registrations Crude Incidence Incidence (ASR Europe) Incidence (95% LCL) Incidence (95% UCL) % Surgery % Chemotherapy % Radiotherapy % No Treatment Diagnosed in Network Treated in Network C50 BREAST Total Registrations Crude Incidence Incidence (ASR Europe) Incidence (95% LCL) Incidence (95% UCL) Total Deaths Crude Mortality Mortality (ASR Europe) Mortality (95% LCL) Mortality (95% UCL) % Surgery % Chemotherapy % Radiotherapy % Hormone Therapy % Other Treatment % No Treatment Diagnosed in Network Treated in Network C53 CERVIX Total Registrations Crude Incidence Incidence (ASR Europe) Incidence (95% LCL) Incidence (95% UCL) Total Deaths Crude Mortality Mortality (ASR Europe) Mortality (95% LCL) Mortality (95% UCL) % Surgery % Chemotherapy % Radiotherapy % No Treatment Diagnosed in Network Treated in Network C54 UTERUS FIG 1.4 Total Registrations Crude Incidence Incidence (ASR Europe) Incidence (95% LCL) Incidence (95% UCL) Total Deaths Crude Mortality Mortality (ASR Europe) Mortality (95% LCL) Mortality (95% UCL) % Surgery % Chemotherapy % Radiotherapy % Hormone Therapy % No Treatment Diagnosed in Network Treated in Network

12 1 9 SECTION 1 >> OVERVIEW OF MAJOR CANCER SITES SUMMARY ANALYSES INCIDENCE, MORTALITY AND SPECIFIC ANALYSES IN : MAJOR CANCERS F M ALL F M ALL F M ALL F M ALL F M ALL C56 OVARY Total Registrations Crude Incidence Incidence (ASR Europe) Incidence (95% LCL) Incidence (95% UCL) Total Deaths Crude Mortality Mortality (ASR Europe) Mortality (95% LCL) Mortality (95% UCL) % Surgery % Chemotherapy % Radiotherapy % Hormone Therapy % No Treatment Diagnosed in Network Treated in Network C61 PROSTATE Total Registrations Crude Incidence Incidence (ASR Europe) Incidence (95% LCL) Incidence (95% UCL) Total Deaths Crude Mortality Mortality (ASR Europe) Mortality (95% LCL) Mortality (95% UCL) % Surgery % Chemotherapy % Radiotherapy % Hormone Therapy % Other Treatment % No Treatment Diagnosed in Network Treated in Network C64 KIDNEY Total Registrations Crude Incidence Incidence (ASR Europe) Incidence (95% LCL) Incidence (95% UCL) Total Deaths Crude Mortality Mortality (ASR Europe) Mortality (95% LCL) Mortality (95% UCL) % Surgery % Chemotherapy % Radiotherapy % Hormone Therapy % No Treatment Diagnosed in Network Treated in Network C67 BLADDER FIG 1.4 Total Registrations Crude Incidence Incidence (ASR Europe) Incidence (95% LCL) Incidence (95% UCL) Total Deaths Crude Mortality Mortality (ASR Europe) Mortality (95% LCL) Mortality (95% UCL) % Surgery % Chemotherapy % Radiotherapy % Hormone Therapy % No Treatment Diagnosed in Network Treated in Network

13 SECTION 1 >> OVERVIEW OF MAJOR CANCER SITES 10 1 SUMMARY ANALYSES INCIDENCE, MORTALITY AND SPECIFIC ANALYSES IN : MAJOR CANCERS F M ALL F M ALL F M ALL F M ALL F M ALL C71 BRAIN Total Registrations Crude Incidence Incidence (ASR Europe) Incidence (95% LCL) Incidence (95% UCL) Total Deaths Crude Mortality Mortality (ASR Europe) Mortality (95% LCL) Mortality (95% UCL) % Surgery % Chemotherapy % Radiotherapy % Hormone Therapy % No Treatment Diagnosed in Network Treated in Network C81-96 HAEMATOLOGICAL Total Registrations Crude Incidence Incidence (ASR Europe) Incidence (95% LCL) Incidence (95% UCL) Total Deaths Crude Mortality Mortality (ASR Europe) Mortality (95% LCL) Mortality (95% UCL) % Surgery % Chemotherapy % Radiotherapy % No Treatment Diagnosed in Network Treated in Network FIG 1.4 Please note: 0 or 0.0 indicates a very small amount of activity is recorded. - indicates there are no cases or activity recorded. Blank indicates value not available or not applicable.

14 2 11 SECTION 2>> NETWORK MANAGEMENT The first part of this section looks more closely at the management of patients within each network. This analysis was also produced in 1998 and there appears to be little variation between the two years. The tables identify movement between networks and patterns of management within networks. Childhood cancers (0-14 years) are excluded from the main tables as their management is mostly at a supra-network level. References to Other networks refer to residents or hospitals from other cancer networks outside the four Northern and Yorkshire cancer networks. This includes Scotland, Wales and Northern Ireland. Overseas refers to patients who are normally resident outside of the UK, who have received part or all of their management in Northern and Yorkshire. KEY POINTS There was little variation in management patterns between 1998 and. The majority of cases coming into the region were from East Lancashire into and Lincolnshire into. 90% of all cases were managed wholly within their network of residence. 78.9% of cases diagnosed in the region received treatment for their cancer. The number of patients in who were referred directly out of the network has increased since This could be the result of improved recording of extra-regional management. COMING INTO THE NETWORK Cases from other networks receiving part of their management in this network (% of all those coming into the network) % % % Other 5 4.1% Overseas 0 0.0% % 2 0.5% % Other % Overseas 0 0.0% 3 0.6% 6 1.2% % Other % Overseas 5 1.0% % % % Other % Overseas % Top 5 Cancers for those coming into the Network C50 Breast 17.1% C34 Lung 12.2% D06 In-Situ Cervix 8.1% C44 Skin NM 8.1% C61 Prostate 8.1% C34 Lung 19.7% C44 Skin NM 11.7% C61 Prostate 7.3% D06 In-Situ Cervix 6.1% C18 Colon 5.4% C50 Breast 5.4% C44 Skin NM 18.6% C61 Prostate 6.2% C34 Lung 5.8% C50 Breast 5.6% C67 Bladder 5.2% C61 Prostate 14.3% C44 Skin NM 14.0% C50 Breast 8.2% C34 Lung 4.9% C18 Colon 4.7% FIG 2.2 FIG of the 111 cases moving into are lung(61) and mesothelioma(8). The majority of these are residents of Wakefield and North Yorkshire health authorities. 190 of the 205 Other cases moving in are residents of Lincolnshire Health Authority. MANAGEMENT WITHIN THE NETWORK (% of Registrations) Total cases diagnosed in the network population Number of these cases managed wholly within the network Top 5 cancers for those managed wholly within the network Number of cases managed wholly within the network by GP Total number of cases in resident population receiving treatment in any network (% of cases treated) Total number of cases receiving treatment in this network regardless of residence % % C44 Skin NM 16.9% C34 Lung 12.5% D06 In-Situ Cervix 10.6% C50 Breast 9.3% C61 Prostate 6.6% % % % The proportion of registrations across the four networks is the same as in The overall percentage of cases managed wholly within their resident network has risen slightly in the smaller networks (, ) and decreased slightly in the larger networks (, ). The majority of the non-melanoma skin cases coming into are from (73) and Scotland (20). The largest proportion of Other cases moving into are from East Lancashire Health Authority % % C44 Skin NM 19.5% C34 Lung 10.5% D06 In-Situ Cervix 8.9% C50 Breast 7.7% C61 Prostate 5.5% % % % % % C44 Skin NM 17.1% C34 Lung 12.0% D06 In-Situ Cervix 9.5% C50 Breast 8.5% C18 Colon 5.7% % % % % % C44 Skin NM 17.6% C34 Lung 10.4% C50 Breast 9.8% D06 In-Situ Cervix 7.8% C61 Prostate 5.4% % % % The top 5 cancers managed within networks are the same as in 1998, except in where colon has moved above prostate. The number of cases managed wholly by GPs has risen slightly across all networks. The overall percentage of patients receiving treatment has also increased slightly (0.6%) between 1998 and.

15 SECTION 2 >> NETWORK MANAGEMENT 12 2 MOVING OUTSIDE THE NETWORK Number of cases referred directly to a hospital outside the network (% of cases in resident population) % % % % Top 5 Cancers for those cases referred directly to a hospital outside the network C44 Skin NM 22.0% C67 Bladder 7.2% C34 Lung 7.0% C61 Prostate 7.0% D06 In-Situ Cervix 7.0% C44 Skin NM 17.0% C61 Prostate 10.8% C50 Breast 9.8% C34 Lung 7.5% C18 Colon 5.2% C44 Skin NM 14.4% C34 Lung 12.0% C50 Breast 9.6% D06 In-Situ Cervix 5.6% C61 Prostate 4.8% C50 Breast 16.1% C44 Skin NM 11.8% D06 In-Situ Cervix 6.7% C61 Prostate 6.7% C34 Lung 5.9% Number of cases referred subsequently to a hospital outside the network (% of cases in resident population) % % % % Top 5 Cancers for those cases referred subsequently to a hospital outside the network C44 Skin NM 7.8% C61 Prostate 7.4% C56 Ovary 6.9% C34 Lung 5.9% C67 Bladder 4.4% C15 Oesophagus 4.4% C50 Breast 25.6% C34 Lung 16.6% C44 Skin NM 7.2% C61 Prostate 4.7% C18 Colon 4.7% C34 Lung 50.0% C18 Colon 11.1% C67 Bladder 11.1% C40 Bone/Cartilage 5.6% C17 Small intestine 5.6% C50 Breast 5.6% C61 Prostate 5.6% C62 Testis 5.6% C34 Lung 63.2% C45 Mesothelioma 8.0% C71 Brain 5.7% C49 Connective tissue 3.4% C81 Hodgkin's Disease 3.4% Number of cases managed wholly outside the network (% of cases in resident population) % % % % Top 5 Cancers for those cases managed wholly outside the network C44 Skin NM 25.0% D06 In-Situ Cervix 8.2% C61 Prostate 7.2% C67 Bladder 6.2% C34 Lung 5.5% C44 Skin NM 17.7% C61 Prostate 9.9% C50 Breast 9.9% C34 Lung 6.7% C18 Colon 5.3% C44 Skin NM 15.5% C34 Lung 13.6% C50 Breast 8.7% D06 In-Situ Cervix 5.8% C61 Prostate 5.8% C50 Breast 15.3% C44 Skin NM 14.9% D06 In-Situ Cervix 8.3% C18 Colon 5.9% C20 Rectum 5.9% Number of cases which actually received treatment outside the network (% of cases in resident population which received treatment) % % % % Top 5 Cancers for those residents who actually received treatment outside the network C44 Skin NM 20.0% C67 Bladder 7.6% C61 Prostate 7.2% D06 In-Situ Cervix 6.1% C56 Ovary 4.3% C50 Breast 19.5% C34 Lung 14.5% C44 Skin NM 11.6% C18 Colon 6.0% C61 Prostate 5.7% C34 Lung 14.8% C50 Breast 11.5% C73 Thyroid 8.2% C44 Skin NM 8.2% C18 Colon 6.6% C34 Lung 22.1% C50 Breast 19.8% C18 Colon 6.9% C44 Skin NM 6.1% D06 In-Situ Cervix 5.3% (% of cases in resident population) Number of cases receiving part or all of their management privately % % % % FIG 2.3 The number of cases being referred directly out of has increased in. The majority of these cases are to extraregional hospitals and to the Friarage hospital in. This is likely to be as a result of improved recording of extraregional treatment information. A large proportion of the cases referred out of is to Lincoln. This reflects the patient flows in. and residents receive a higher percentage of their treatment outside their resident network than and residents. TOP 5 CANCERS MANAGED WHOLLY BY GP'S C44 Skin NM % D04 In-Situ Skin % TOP 5 CANCERS MANAGED BY PRIVATE HOSPITAL C50 Breast % C44 Skin NM % C43 Melanoma % C61 Prostate % FIG 2.4 C34 Lung % C80 Carcinomatosis % FIG 2.5 C18 Colon % D06 In-Situ Cervix %

16 2 13 SECTION 2>> NETWORK MANAGEMENT (CHILDHOOD CANCERS) FIG 2.6 COMING INTO THE NETWORK Matrix showing movement of cases from one network to another in for childhood cancers (0-14yrs) FROM TO OTHER Other Overseas Children (0-14yrs) KEY POINTS There has been very little change in the management of childhood cancers between 1998 and. The total number of cases for the region in was 166. MANAGEMENT WITHIN THE NETWORK CHILDREN (0-14YRS) Total cases diagnosed in the network resident population % % % % % of registrations Number of these cases managed wholly within the network 2 7.4% % % % % of cases diagnosed in network FIG 2.7 Total no. of cases in resident population receiving treatment in any network % % % % % of cases diagnosed in network No. of cases receiving treatment in network regardless of residence 2 1.3% 3 2.0% % % % of cases treated MOVING OUTSIDE THE NETWORK CHILDREN (0-14YRS) FIG 2.8 Number of cases referred directly to a hospital outside the network % % 2 4.1% 6 9.1% % of cases in resident population No. of cases referred subsequently to a hospital outside the network % % 2 4.1% 0 0.0% % of cases in resident population Number of cases managed wholly outside the network % % 1 2.0% 3 4.5% % of cases in resident population No. of cases which actually received treatment outside the network % % 1 2.3% 1 1.8% % of all treated cases in res.pop. Number of cases receiving part or all of their management privately 0 0.0% 0 0.0% 0 0.0% 2 1.2% % of cases in resident population The total number of registrations in the 0-14 years age group is less in (169) than in 1998 (197). A number of ascertainment checks have already taken place for childhood cancers for. Figure 2.6 shows that the majority of childhood cancers are managed at a supra-network level by the two larger networks, and. Figure 2.7 confirms that and combined treat 94% of the childhood cancers across the region. Only a small percentage of and cases receive any treatment outside of their resident network (Figure 2.8). TOP 5 CHILDHOOD CANCERS C91 Lymphoid Leukaemia % C71 Brain % C92 Myeloid Leukaemia % C83 Diffuse NHL 8 4.8% C64 Kidney 8 4.8% FIG 2.9 The top five childhood cancers in are the same as in 1998, with one or two percentage increases or decreases due to the very small number of cases.