Lung Cancer Patient Outcomes

Transcription

1 Lung Cancer Patient Outcomes Dr Neal Navani MA MSc PhD FRCP Consultant Respiratory Physician, UCLH Clinical Senior Lecturer, UCL Lead Clinician for Lung Cancer, UCLH Co-Clinical Lead, NLCA, Royal College of Physicians Dr John Conibear BSc MBBCh MRCP MSc FRCR MD(Res) Consultant Clinical Oncologist, St. Bartholomew s Hospital Clinical Director for Lung Cancer, Barts Health

2 Outline Update from the National Lung Cancer Audit Progress and challenges in north and east London Value across the London cancer journey Evaluate data as close to real time as possible Capturing outcomes beyond survival Using outcomes as lever to increase value for our patients

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13 Adjusted for age, gender, PS, stage, SES

14 Number of surgical resections for lung cancer First audit report Increase in numbers of thoracic surgeons Source: Royal College of Physicians & Society of Cardiothoracic Surgeons 2017

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17 Adjusted surgical resection rates varied from 4.8 to 40% 60 organisations failed to meet the audit standard of 17% Seven organisations have been notified of their outlier status

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19 NLCA data Variation persists Some excellent results; room for improvement for all trusts Use the data for Quality Improvement Molecular spotlight audit 2018 Feedback results to trusts

20 ICHOM Standard Set for Lung Cancer: Outcomes Treatment approaches covered Surgery Radiotherapy Chemotherapy Targeted therapy Immunotherapy Other Sponsored by: 2015 ICHOM. All rights reserved. When using this Standard Set of outcomes, or quoting therefrom, in any way, we solely require that you always make a reference to ICHOM a s the source so that this organization can continue its work to define Standard Sets. Copyright 2015 by the International Consortium for Health Outcomes Measurement. All rights reserved.

21 ICHOM Implementation Localised prostate: UCLH Lung: UCLH & Barts Purpose of collecting ICHOM datasets: to collect outcomes other than overall survival that matter to patients, providers and purchasers to evaluate in more detail the clinical benefits of treatments and treatment pathways real world outcome data to develop an understanding of the value of interventions and care assisting choice To allows for international comparisons

22 Outcomes as the lever to allow the development of a value-based healthcare system Value = Patient health outcomes achieved Cost of delivering those outcomes Improve outcomes Starting point is to measure and improve the health results that matter most for a patient's condition Reduce costs Streamline care delivery to only those services that improve outcomes Increase value Better outcomes at equal or lower cost leads to higher value

23 MDT Balanced scorecard core aim Be the one stop shop to motivate MDTs to collect, review and act on data relating to Activity, Performance and Outcomes Breast Improve understanding of value across whole pathways of cancer care and their components Enable clinical teams to validate data as close to real time as possible Prostate Evaluate whether patients are on the best desired pathways Evaluate clinical outcomes of treatment / treatment pathways

24 ICHOM Standard Set for Lung Cancer: Demographic Factors Date of birth Sex Ethnicity Educational level Baseline Clinical Factors Weight loss Comorbidities Risk Factor/Initial Condition Patient-reported health status Smoking status Performance status Pulmonary function Baseline Tumor Factors Basis of diagnosis Histology ALK translocation EGFR mutation Clinical stage Pathological stage Treatment Factors Treatment intent Completed treatment Measure Details N/A Sex at birth Determined by country Level of schooling completed Unintentional weight loss Modified Self-administered Comorbidity Questionnaire (SCQ) Tracked via EORTC QLQ-C30 and EORTC QLQ-LC13 Smoking status at diagnosis ECOG / WHO scale for performance status Absolute and predicted FEV-1 Diagnosis by clinical, histological or cytological assessment Lung cancer histology Presence of ALK translocation Presence of activating EGFR mutation Clinical stage per UICC / IASLC / AJCC 7th edition Pathological stage per UICC / IASLC / AJCC 7th edition Curative or palliative treatment intent Completed treatment with or without dose reduction Copyright 2015 by the International Consortium for Health Outcomes Measurement. All rights reserved. 24

25 ICHOM Standard Set for Lung Cancer: Patient-reported outcomes, QoL and adverse events measures on follow-up Patient population Measure Supporting information Waiting times All patients Acute complications of treatment Patients undergoing surgical resection Patients undergoing radiotherapy Patients-undergoing systemic therapy Quality of life All patients Time from diagnosis to treatment Major surgical complications Major radiation complications Major systemic therapy complications EORTC QLQC-30 questionnaire EORTC LC13 questionnaire Date of pathology; treatment start date Presence or absence of a grade 3 Clavien- Dindo complication within 6 months of surgery Presence or absence of a named grade 3 or 4 Adverse Event whilst on therapy or within 6 months of treatment General Health QoL Lung cancer specific QoL Timing At start of treatment Updates at least annually Updates at least annually Baseline, 3, 6 and 12 months posttreatment then annually for life Data source Cancer Waiting Times Clinical / patient Patient completed Copyright 2015 by the International Consortium for Health Outcomes Measurement. All rights reserved. 25

26 Timing of data collection PROMS: Proposed minimum time points for capture are baseline, 3 and 6 months after initiation of treatment, 1 year after treatment and annually Adverse events: Reported during treatment and up to 6 months after treatment Initiation of treatments / other events: Recorded with specific date (surgery, chemotherapy, radiotherapy etc.) Copyright 2015 by the International Consortium for Health Outcomes Measurement. All rights reserved. 26

27 Admin function carried out by all team members

28 Example of the types of questions included in the PROMs survey Tool Question Response When to collect Do you have any trouble doing strenuous activities, like carrying a heavy shopping bag or a suitcase? EORTC QLQ- C30 EORTC QLQ- LC13 Do you need help with eating, dressing, washing yourself or using the toilet During the past week: How much did you cough? Have you had tingling hands or feet? 0 = Not at all 1 = A little 2 = Quite a bit 3 = Very much Baseline 3 months post initiation of treatment 6 months post initiation of treatment 1 year post initiation of treatment Tracked ongoing annually for life Copyright 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved. 28

29 Acknowledgements UCLH Cancer Collaborative lung cancer teams Rosie Dickinson and the Project team, RCP NLCA Clinical Leads Paul Beckett, Susie Harden Prof Mick Peake, Clinical Director, Centre for Cancer Outcomes This work uses data provided by patients and collected by the NHS as part of their care and support.