Ovarian Cancer Quality Performance Indicators Patients diagnosed between October 2013 and September 2016 Publication date 20 February 2018 An Official Statistics publication for Scotland
This is an Official Statistics Publication The Official Statistics (Scotland) Order 2008 authorises NHS National Services Scotland (the legal name being the Common Services Agency for the Scottish Health Service) to produce official statistics. All official statistics should comply with the UK Statistics Authority s Code of Practice which promotes the production and dissemination of official statistics that inform decision making. They can be formally assessed by the UK Statistics Authority s regulatory arm for National Statistics status. Find out more about the Code of Practice at: https://www.statisticsauthority.gov.uk/osr/code-of-practice/ Find out more about official statistics at: https://www.statisticsauthority.gov.uk/national-statistician/producers-of-official-statistics/ 2
Contents Introduction... 4 Results and Commentary... 9 Case Ascertainment... 9 Overall Performance Summary... 10 Quality Performance Indicators... 14 Clinical Trials... 41 List of Tables... 44 Contact... 45 Further Information... 45 Rate this publication... 45 Appendices... 46 Appendix 1 Background information... 46 Appendix 3 Ovarian Cancer Clinical Trials... 49 Appendix 4 Publication Metadata... 50 Appendix 5 Early access details... 52 Appendix 6 ISD and Official Statistics... 53 3
Introduction The cancer strategy Beating Cancer: Ambition and Action published in March 2016 builds on the commitment made in the Better Cancer Care plan to 'develop a work programme which will define how we will take forward quality indicators for cancer services' by further supporting a culture of continuous quality improvement in cancer care across NHSScotland. The new cancer strategy states a commitment to improving data collection to advance the quality and delivery of care for cancer patients. To achieve this, the Scottish Cancer Taskforce established the National Cancer Quality Steering Group (NCQSG), which includes responsibility for: The development of small sets (approximately 10-15 indicators) of tumour specific national quality performance indicators (QPIs) as a proxy measure of quality care. Overseeing the implementation of the national governance framework that underpins the reporting of performance against these national QPIs. The QPIs have been developed collaboratively with the three Regional Cancer Networks: North of Scotland Cancer Network (NOSCAN), South East Scotland Cancer Network (SCAN), West of Scotland Cancer Network (WoSCAN), Information Services Division (ISD), and Healthcare Improvement Scotland. The QPIs are published on the Healthcare Improvement Scotland website. These indicators, used to drive quality improvement in cancer care across NHSScotland are kept under regular review; NHS Boards will be required to report against QPIs as part of a mandatory national cancer quality programme. ISD support NHS Boards in improving the quality of local data collection and reporting through the production of data validation specifications, and measurability criteria for QPIs. The current data sets are outlined on the Cancer Audit website. A rolling programme of reporting is planned across many tumour sites. National reports will include comparative reporting of performance against QPIs at NHS Board level across NHS Scotland, trend analysis and survival analysis (where applicable). This approach will help overcome existing issues relating to the reporting of small volumes in any one year. This report assesses performance against 9 Ovarian Cancer QPIs using clinical audit data relating to patients diagnosed with ovarian cancer for the period from October 2013 to September 2016. 4
Data collection and analysis Ovarian cancer QPI data for patients diagnosed between October 2013 and September 2016 were collected by NHS Boards, supported by the regional cancer networks, and then analysed against the Ovarian cancer measurability document. Aggregated analysed data were then submitted to ISD via a data collection template for collation to allow comparisons at NHS Board level. Data quality and completeness Small numbers: Where the number of cases meeting the denominator criteria for any indicator is between one and four, the percentage calculation has not been shown on any associated charts or tables. This is to avoid any unwarranted variation associated with small numbers and to minimise the risk of disclosure. Any charts or tables impacted by this are denoted with a dash (-). However, any commentary provided by NHS Boards relating to the impacted indicators will be included as a record of continuous improvement. Baseline Review: Following baseline review and year 1 publication of ovarian cancer QPIs data, some changes were made to measurability in order that the QPIs appropriately measured what they were intended to. These were positive changes and led to more focussed analysis in year 2. However, the alterations to measurability mean that year 1 and year 2 results may not be directly comparable for some QPIs. Formal Review: In order to ensure the success of the National Cancer QPIs in driving quality improvement in cancer care across NHS Scotland it is critical that the QPIs continue to be clinically relevant and focus on areas which will result in improvements to the quality of patient care. It was proposed that a formal review of all QPIs should take place following 3 years national comparative reporting, with tumour specific Regional Clinical Leads undertaking a key role in determining the need and extent of the review required. 5
For ovarian cancer, this review has already taken place; revised ovarian cancer QPIs for implementation from year 4 onwards will be published later in 2018, following public consultation. Any proposed changes to the QPIs as a result of this review will be noted in this report. Survival Analysis: For future tumour specific survival analyses, it has been agreed to use the Cancer Audit QPI dataset rather than the Cancer Registry dataset that has been used in the past. This should provide benefits in terms of improved accuracy and more specific and detailed analysis. Due to time limitations and availability of data in time for this release, therefore, it has been agreed to undertake ovarian cancer survival analysis at a later date. 6
Foreword from Ovarian Cancer Clinical Leads The three Regional Cancer Networks (North of Scotland Cancer Network (NOSCAN), South East Scotland Cancer Network (SCAN), and West of Scotland Cancer Network (WoSCAN)) aim to promote the highest standards of cancer care and equity of access to cancer services across Scotland. The development and introduction of national Quality Performance Indicators (QPIs) across Scotland represents a major step forward for patients with Ovarian Cancer. This is the first report of performance against the Ovarian Cancer QPIs at a national level and provides results from the first three years of QPI recording across the three Regional Cancer Networks. Results were discussed at the Scottish Gynaecological Cancer Networks Collaborative Meeting held in November 2017. The QPI results have shown that overall, the quality of ovarian cancer services across Scotland is good in many areas of care. For example, performance against QPIs for imaging prior to treatment (QPI 2), histo/cytological diagnosis (QPI 7(i)), surgical outcomes for patients with advanced disease having primary surgery (QPI 5) or delayed primary surgery (QPI 8(ii)) and pathological reporting (QPI 6) were very good. In other areas, improvements in service performance can be seen over the years of reporting, for example in the recording of the Risk of Malignancy Index (QPI 1) and the proportion of patients having a histological diagnosis (QPI 7(ii)). However, some challenges remain and these are outlined below: QPI 3: Treatment planned and reviewed at a multi-disciplinary team meeting. It is acknowledged that the target for this QPI is challenging as there will always be some patients who only present at time of requiring emergency surgery, or where ovarian cancer is an incidental finding of other primary treatment, neither of which will be discussed at MDT prior to treatment. Though these cases will make the target for this QPI challenging, it is considered useful in ensuring that these patients are reviewed. Performance against this indicator is similar across the country suggesting there are no concerns with the MDT processes in any specific regions or NHS Boards. QPI 7 (ii): Histological Diagnosis prior to starting neo-adjuvant chemotherapy. Over the three years of reporting, performance against this QPI has improved in both SCAN and WoSCAN, with regions confident that this QPI had resulted in an improvement in the decisions on the treatment provided for some patients. All NHS Boards are encouraged to ensure patients have a histological diagnosis prior to starting neo-adjuvant chemotherapy where possible. QPI 9: First-line Chemotherapy. This QPI has not been met in any of the regions in Scotland. It is acknowledged that some patients are not fit for chemotherapy while for some tumour types chemotherapy is not indicated. It is proposed that this QPI will be amended to 7
exclude patients with tumours where chemotherapy is not considered beneficial. This amendment will help focus the measurement on the correct group of patients and ongoing review of patients not meeting the QPI should be helpful in ensuring that chemotherapy treatment is given where appropriate. A Formal Review of the Ovarian Cancer QPIs is currently underway. As part of this review some amendments to the QPI definitions are being considered, some targets made more challenging and a number of new indicators are being developed which may prove more challenging for NHS Boards to meet in future years. We are confident that implementation of these new QPIs will drive further quality improvement in ovarian cancer services across NHSScotland. Dr Mary Cairns Consultant in Gynaecological Oncology NOSCAN Clinical Lead for Ovarian Cancer Dr Cameron Martin Consultant Gynaecologist SCAN Clinical Lead for Gynaecological Cancers Dr Kevin Burton Consultant Gynaecological Oncologist WoSCAN Clinical Lead for Gynaecological Cancers 8
Results and Commentary Case Ascertainment Case ascertainment is a measure of data quality and is calculated by comparing the number of new patients captured by the cancer audit with a five year average of the numbers recorded on the cancer registry. A five year average is used for registry data as the information is not available until sometime after the year under examination. This is due to data collection and verification processes. As the number of cases will vary each year, it is possible for case ascertainment to be over or under 100%. Therefore, the figures presented should be seen as an indication only. The average case ascertainment across Scotland in the year to March 2016 was 73.5%. It should be noted that the lower case ascertainment for ovarian cancer is due to the fact that the cancer audit dataset is restricted to patients with a diagnosis of epithelial ovarian cancer, which is just a subset of those identified with ovarian cancer in the Scottish Cancer Registry. 200.0 180.0 160.0 140.0 120.0 100.0 80.0 60.0 40.0 20.0 Estimated Case Ascertainment (%) 0.0 Grampian Highland Orkney Shetland Tayside Western Isles NOSCAN Borders Dumfries & Galloway Fife Lothian SCAN Ayrshire & Forth Valley Greater Lanarkshire WoSCAN Scotland Arran Glasgow & Clyde NOSCAN SCAN WoSCAN Scotland No. of Audit Records Diagnosed in 2015/16 Average No. of Cancer Registrations: 2011-2015 Estimated Case Ascertainme nt % 2013/14 2014/15 2015/16 Average No. of Cancer Registrations : 2011-2015 No. of Audit Records Diagnosed in 2013/14 No. of Audit Records Diagnosed in 2014/15 Estimated Case Ascertainment % Average No. of Cancer Registrations: 2010-2014 Estimated Case Ascertainment % NOSCAN 127 164 77.5 115 164 70.2 99 166 59.6 Grampian 52 74 70.7 54 74 73.4 34 71 47.8 Highland 25 30 83.3 22 30 73.3 19 31 62.1 Orkney 1 1 125.0 0 1 0.0 0 1 0.0 Shetland 1 2 62.5 1 2 62.5 1 1 100.0 Tayside 43 55 78.2 36 55 65.5 45 60 75.3 Western Isles 5 3 178.6 2 3 71.4 0 3 0.0 SCAN 111 180 61.7 113 180 62.8 126 182 69.2 Borders 14 14 102.9 7 14 51.5 11 14 78.6 Dumfries & Galloway 17 19 88.5 16 19 83.3 17 20 85.9 Fife 28 37 75.7 30 37 81.1 27 36 75.8 Lothian 52 110 47.2 60 110 54.4 71 113 62.9 WoSCAN 236 301 78.3 235 301 78.0 204 305 66.8 Ayrshire & Arran 41 52 79.2 45 52 86.9 35 52 67.3 Forth Valley 25 32 77.6 20 32 62.1 24 36 67.0 Greater Glasgow & Clyde 120 160 74.9 114 160 71.2 116 160 72.7 Lanarkshire 50 57 87.4 56 57 97.9 29 58 50.0 Scotland 474 645 73.5 463 645 71.8 429 654 65.6 9
Overall Performance Summary The tables below summarise the overall % performance across the country for each QPI. D by Health Board of Diagnosis S by Health Board of Surgery NOSCAN: 10
SCAN: D by Health Board of Diagnosis S by Health Board of Surgery D by Health Board of Diagnosis 11
D by Health Board of Diagnosis WoSCAN: S by Health Board of Surgery 12
2013/14 2014/15 2015/16 2013/14 2014/15 2015/16 2013/14 2014/15 2015/16 Information Services Division Clinical Trials Summary Table by Scottish Cancer Research Network (SCRN) SCRN - North & East SCRN - South East SCRN - West Target not met Met or exceeded target Clinical Trials - Interventional - > 7.5% 3.0% 6.1% 4.9% 10.4% 15.0% 2.8% 14.4% 7.0% 11.0% Clinical Trials - Translational - > 15% 14.5% 9.8% 10.4% 37.9% 56.7% 38.3% 7.9% 6.0% 3.3% No data matching QPI criteria Data not shown due to small numbers 13
Quality Performance Indicators The following section includes a detailed summary of each of the nine ovarian cancer QPIs outlining the variation at NHS Board level. Charts are colour coded by reporting year or by network if reporting a single year. Where performance at either level is shown to fall below the target, commentary from the relevant NHS Board is included to provide context to the variation. Information in this report is shown by either Health Board of diagnosis or Health Board of surgery as noted. Further information at hospital level is available from the data tables, where applicable. QPI 1: Risk of Malignancy Index recorded in the patient notes RMI (Risk of Malignancy Index) score is used to inform the multidisciplinary team (MDT) decision regarding the need for specialist surgical intervention and is calculated after performing an ultrasound scan. Numerator: Number of patients with FIGO Stage 1 epithelial ovarian cancer having RMI score recorded in their notes prior to any definitive surgical intervention. Denominator: All patients with FIGO Stage I epithelial ovarian cancer undergoing definitive surgical intervention. Exclusions: Patients presenting for surgery as an emergency Patients who do not undergo ultrasound scan Target: 90% The percentage of patients in Scotland with FIGO Stage 1 epithelial ovarian cancer having RMI recorded prior to surgery steadily increased from 27% in 2013/14 to 72% in 2015/16. Although still below target, this is an encouraging trend. This improvement is also observed in NOSCAN over the 3 years with the network achieving 100% in year 3, although with relatively small numbers. In SCAN, the target was met in year 2 and WoSCAN shows significant improvement in year 3 but still below target. In both networks though, small numbers may be contributing to this variation. At the baseline review after year 1, it was noted that since an ultrasound scan is required to calculate RMI and that it is not relevant to undergo ultrasound if a CT scan is performed; then such patients should be excluded from this QPI. This exclusion was added from year 2 and may account for some of the improvement observed from year 1 to year 2. 14
100 QPI 1 - Risk of Malignancy Index (RMI I) recorded in the patient notes by Health Board of Diagnosis 90 90% 80 70 60 50 40 30 20 10 0 Grampian Highland Orkney Shetland Tayside Western Isles NOSCAN Borders Dumfries & Galloway Fife Lothian SCAN Ayrshire & Forth Valley Greater Lanarkshire WoSCAN Scotland Arran Glasgow & Clyde NOSCAN SCAN WoSCAN Scotland 2013/14 2014/15 2015/16 Target 2015/16 Past % Performance NR for NR for NR for NHS Board/Region % Performance Numerator Denominator Numerator Exclusion Denominator 2013/14 2014/15 Grampian 100.0 9 9 40.0 44.4 Highland - - - * - Orkney * * * * * Shetland * * * * * Tayside 100.0 5 5 0.0 100.0 Western Isles - - - * * NOSCAN 100.0 19 19 16.7 72.2 Borders - - - - - Dumfries & Galloway - - - - - Fife - - - - - Lothian 57.1 4 7 8.3 100.0 SCAN 78.6 11 14 17.4 94.4 Ayrshire & Arran 0.0 0 7 2 0.0 11.1 Forth Valley - - - 100.0 - Greater Glasgow & Clyde 69.2 9 13 1 25.9 14.3 Lanarkshire 50.0 3 6-33.3 WoSCAN 48.1 13 27 3 35.0 22.6 Scotland 71.7 43 60 3 26.7 55.2 Source: Cancer audit - Data not shown due to small numbers * No data matching QPI criteria Several Boards commented that since many patients no longer undergo ultrasound, RMI cannot be calculated. This was discussed at the formal review where it was recognized that practice has changed with many patients now undergoing a CT scan instead of ultrasound. Since the RMI cannot be calculated without ultrasound imaging then this QPI may no longer be beneficial and does not influence clinical management. Clinical practice has changed and rapid turnaround to CT now in place. It has, therefore, been proposed that this QPI is archived from year 4 onwards. 15
Due to the small numbers involved in each year, the 3 year aggregate figures are shown below for reference. QPI 1 3 year aggregate figures NHS Board/Region % Performance Numerator Denominator Grampian 65.2 15 23 Highland 100.0 7 7 Orkney * * * Shetland * * * Tayside 61.1 11 18 Western Isles - - - NOSCAN 69.4 34 49 Borders 75.0 6 8 Dumfries & Galloway 55.6 5 9 Fife 70.0 7 10 Lothian 50.0 14 28 SCAN 58.2 32 55 Ayrshire & Arran 4.5 1 22 Forth Valley 100.0 8 8 Greater Glasgow & Clyde 33.3 18 54 Lanarkshire 50.0 7 14 WoSCAN 34.7 34 98 Scotland 49.5 100 202 16
QPI 2: Extent of disease assessed by Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) prior to treatment It is necessary to fully image the pelvis and abdomen prior to starting any definitive treatment in order to establish the extent of disease and minimise unnecessary treatment. Numerator: Number of patients with epithelial ovarian cancer having a CT scan or MRI of the abdomen and pelvis carried out prior to starting treatment. Denominator: All patients with epithelial ovarian cancer. Exclusions: Patients who decline to undergo investigation. Patients presenting for surgery as an emergency. Target: 90% With the exception of NHS Shetland in year 2 (small numbers), all NHS Boards met the target in each year. Overall in Scotland, the percentage of patients with ovarian cancer having a CT or MRI scan prior to treatment was consistently above 97%. 100 QPI 2 - Extent of disease assessed by Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) prior to treatment by Health Board of Diagnosis 90 90% 80 70 60 50 40 30 20 10 0 Grampian Highland Orkney Shetland Tayside Western Isles NOSCAN Borders Dumfries & Galloway Fife Lothian SCAN Ayrshire & Forth Valley Greater Lanarkshire WoSCAN Scotland Arran Glasgow & Clyde NOSCAN SCAN WoSCAN Scotland 2013/14 2014/15 2015/16 Target 17
2015/16 Past % Performance NHS Board/Region % Performance Numerator Denominator NR for Numerator NR for Exclusion NR for Denominator 2013/14 2014/15 Grampian 100.0 52 52 100.0 96.6 Highland 92.0 23 25 100.0 100.0 Orkney * * * * * Shetland - - - - - Tayside 100.0 41 41 100.0 97.1 Western Isles 100.0 5 5 * - NOSCAN 98.4 122 124 100.0 96.6 Borders 100.0 14 14 100.0 100.0 Dumfries & Galloway 100.0 16 16 100.0 100.0 Fife 100.0 28 28 96.2 92.6 Lothian 100.0 51 51 98.5 96.6 SCAN 100.0 109 109 98.3 96.3 Ayrshire & Arran 100.0 41 41 100.0 100.0 Forth Valley 100.0 24 24 100.0 100.0 Greater Glasgow & Clyde 98.3 114 116 96.4 97.3 Lanarkshire 93.8 45 48 100.0 98.0 WoSCAN 97.8 224 229 97.9 98.2 Scotland 98.5 455 462 98.5 97.3 Source: Cancer audit - Data not shown due to small numbers * No data matching QPI criteria It was noted by several NHS Boards that some patients did not have imaging prior to treatment as cancer was not suspected pre-operatively. At the formal review, it was proposed to increase the target from 90% to 95%. This will be in place for future reporting of this indicator. 18
QPI 3: Treatment planned and reviewed at a multi-disciplinary team meeting Evidence suggests that patients with cancer managed by a multidisciplinary team have a better outcome. There is also evidence that the multidisciplinary management of patients increases their overall satisfaction with their care. Numerator: Number of patients with epithelial ovarian cancer discussed at the MDT before definitive treatment. Denominator: All patients with epithelial ovarian cancer Exclusions: Patients who died before first treatment. Target: 95% Overall in Scotland in 2015/16, 92% of patients with epithelial ovarian cancer were discussed at the MDT before definitive treatment. This is similar to the previous 2 years but below the 95% target. In year 3, only NHS Shetland (small numbers), NHS Tayside, NHS Fife, NHS Ayrshire & Arran and NHS Forth Valley achieved the target. 100 90 QPI 3 - Treatment planned and reviewed at a multi-disciplinary team meeting by Health Board of Diagnosis 95% 80 70 60 50 40 30 20 10 0 Grampian Highland Orkney Shetland Tayside Western Isles NOSCAN Borders Dumfries & Galloway Fife Lothian SCAN Ayrshire & Forth Valley Greater Lanarkshire WoSCAN Scotland Arran Glasgow & Clyde NOSCAN SCAN WoSCAN Scotland 2013/14 2014/15 2015/16 Target 19
2015/16 Past % Performance NR for NR for NR for NHS Board/Region % Performance Numerator Denominator Numerator Exclusion Denominator 2013/14 2014/15 Grampian 90.9 50 55 93.9 94.6 Highland 92.0 23 25 100.0 95.0 Orkney - - - * * Shetland - - - - - Tayside 95.3 41 43 97.4 88.2 Western Isles 60.0 3 5 * - NOSCAN 90.8 118 130 96.7 92.0 Borders 92.9 13 14 81.8 100.0 Dumfries & Galloway 82.4 14 17 87.5 75.0 Fife 100.0 27 27 77.8 72.4 Lothian 94.2 49 52 81.7 95.0 SCAN 93.6 103 110 81.6 86.6 Ayrshire & Arran 97.6 40 41 91.4 81.8 Forth Valley 100.0 24 24 95.5 95.0 Greater Glasgow & Clyde 89.6 103 115 92.7 94.3 Lanarkshire 91.8 45 49 89.7 80.4 WoSCAN 92.6 212 229 92.3 88.5 Scotland 92.3 433 469 90.0 88.9 Source: Cancer audit - Data not shown due to small numbers * No data matching QPI criteria Many of the NHS Boards conducted reviews into those patients not meeting target and one of the most common reasons for patients not being discussed at the MDT prior to treatment was patients receiving emergency surgery. There was some discussion around emergency cases at the baseline review and whether these should be excluded from the QPI. However it was agreed that the tolerance in the target should cover this and the performance will continue to be monitored. In other cases across several boards, cancer was not suspected prior to surgery and therefore these patients were not discussed at MDT. 20
QPI 4(i): Patients with early stage disease have an adequate staging operation patients undergoing primary surgery. Stage of disease is an important prognostic factor influencing choice of therapy and quality of surgical staging is a key determinant of adjuvant chemotherapy. Numerator: Number of early stage (FIGO Stage 1) epithelial ovarian cancer patients having primary surgery involving TAH, BSO, omentectomy and washings. Denominator: All early stage (FIGO Stage 1) epithelial ovarian cancer patients undergoing primary surgery. Exclusions: Patients having fertility conserving surgery. Patients with risk of malignancy index <200 Patients presenting for emergency surgery Target: 95% In each of the 3 reporting years the target was missed at a national level and with a decreasing trend. There are relatively few patients in this cohort so caution is advised when comparing across NHS Boards. At network level, only SCAN achieved target in year 3. 100 90 QPI 4 - Patients with early stage disease have an adequate staging operation (i) by Health Board of Surgery 95% 80 70 60 50 40 30 20 10 0 Grampian Highland Orkney Shetland Tayside Western Isles NOSCAN Borders Dumfries & Galloway Fife Lothian SCAN Ayrshire & Forth Valley Greater Lanarkshire WoSCAN Scotland Arran Glasgow & Clyde NOSCAN SCAN WoSCAN Scotland 2013/14 2014/15 2015/16 Target 21
2015/16 Past % Performance NR for NR for NR for NHS Board/Region % Performance Numerator Denominator Numerator Exclusion Denominator 2013/14 2014/15 Grampian 80.0 4 5 100.0 100.0 Highland - - - * - Orkney * * * * * Shetland * * * * * Tayside 80.0 4 5 100.0 - Western Isles * * * * * NOSCAN 72.7 8 11 100.0 100.0 Borders - - - - * Dumfries & Galloway - - - - - Fife 100.0 5 5-80.0 Lothian - - - 78.6 100.0 SCAN 100.0 13 13 86.4 89.5 Ayrshire & Arran 83.3 5 6 6 100.0 85.7 Forth Valley * * * 80.0 * Greater Glasgow & Clyde 80.6 25 31 8 3 84.6 87.0 Lanarkshire 60.0 3 5-60.0 WoSCAN 78.6 33 42 14 3 86.8 82.9 Scotland 81.8 54 66 14 3 88.9 87.7 Source: Cancer audit - Data not shown due to small numbers * No data matching QPI criteria Several NHS Boards reviewed cases and provided detailed reasons for patients not meeting the QPI, including incidental findings and co-morbidities. Due to the small numbers involved in each year, the 3 year aggregate figures are shown below for reference. QPI 4(i) 3 year aggregate figures NHS Board/Region % Performance Numerator Denominator Grampian 94.1 16 17 Highland - - - Orkney * * * Shetland * * * Tayside 93.3 14 15 Western Isles * * * NOSCAN 91.2 31 34 Borders 100.0 5 5 Dumfries & Galloway 87.5 7 8 Fife 92.3 12 13 Lothian 89.3 25 28 SCAN 90.7 49 54 Ayrshire & Arran 89.5 17 19 Forth Valley 80.0 4 5 Greater Glasgow & Clyde 83.8 67 80 Lanarkshire 63.6 7 11 WoSCAN 82.6 95 115 Scotland 86.2 175 203 22
QPI 4(ii): Patients with early stage disease have an adequate staging operation patients operated on by a gynaecological oncologist. Stage of disease is an important prognostic factor influencing choice of therapy and quality of surgical staging is a key determinant of adjuvant chemotherapy. Patients suspected of having ovarian cancer should be operated on by a gynaecological oncologist; this has been shown to improve survival for women with ovarian cancer. Numerator: Number of early stage (FIGO Stage 1) epithelial ovarian cancer patients having primary surgery involving TAH, BSO, omentectomy and washings. Denominator: All early stage (FIGO Stage 1) epithelial ovarian cancer patients operated on by a gynaecological oncologist. Exclusions: Patients having fertility conserving surgery. Patients with risk of malignancy index <200 Patients presenting for emergency surgery Target: 95% The second part of QPI4 adds the additional specification of the primary surgery being performed by a gynaecological oncologist. This further reduces the numbers in this cohort; therefore, small numbers may be contributing to any variation at NHS Board level. At national level, however, the target was not achieved in any of the three reporting years. 100 90 QPI 4 - Patients with early stage disease have an adequate staging operation (ii) by Health Board of Surgery 95% 80 70 60 50 40 30 20 10 0 Grampian Highland Orkney Shetland Tayside Western Isles NOSCAN Borders Dumfries & Galloway Fife Lothian SCAN Ayrshire & Forth Valley Greater Lanarkshire WoSCAN Scotland Arran Glasgow & Clyde NOSCAN SCAN WoSCAN Scotland 2013/14 2014/15 2015/16 Target 23
2015/16 Past % Performance NR for NR for NR for NHS Board/Region % Performance Numerator Denominator Numerator Exclusion Denominator 2013/14 2014/15 Grampian 80.0 4 5-100.0 Highland * * * * * Orkney * * * * * Shetland * * * * * Tayside * * * - * Western Isles * * * * * NOSCAN 80.0 4 5 100.0 100.0 Borders - - - - * Dumfries & Galloway - - - - - Fife 100.0 5 5 - - Lothian - - - 100.0 100.0 SCAN 92.3 12 13 100.0 69.2 Ayrshire & Arran * * * - * Forth Valley * * * - * Greater Glasgow & Clyde 87.5 21 24 6 1 90.0 94.7 Lanarkshire * * * * * WoSCAN 87.5 21 24 6 1 88.5 94.7 Scotland 88.1 37 42 6 1 94.3 86.8 Source: Cancer audit - Data not shown due to small numbers * No data matching QPI criteria QPI4 was discussed at the formal review where it was proposed to remove specification (ii) and remove the RMI>200 exclusion category. Due to this, a change to the target is to be considered. Due to the small numbers involved in each year, the 3 year aggregate figures are shown below for reference. QPI 4(ii) 3 year aggregate figures NHS Board/Region % Performance Numerator Denominator Grampian 93.3 14 15 Highland * * * Orkney * * * Shetland * * * Tayside - - - Western Isles * * * NOSCAN 93.8 15 16 Borders 100.0 5 5 Dumfries & Galloway 37.5 3 8 Fife 100.0 12 12 Lothian 100.0 23 23 SCAN 89.6 43 48 Ayrshire & Arran - - - Forth Valley - - - Greater Glasgow & Clyde 90.5 57 63 Lanarkshire * * * WoSCAN 89.9 62 69 Scotland 90.2 120 133 24
QPI 5(i): No macroscopic residual disease following surgery for advanced disease Improved patient outcomes are observed in patients with no visible residual disease following surgical resection. Numerator: Number of patients with advanced epithelial ovarian cancer (FIGO Stage 2 or higher) with no macroscopic residual disease following surgery. Denominator: All patients with advanced epithelial ovarian cancer (FIGO Stage 2 or higher) undergoing surgery. Exclusions: Patients with FIGO Stage 4 disease. Target: 30% In 2015/16, of the 109 patients with advanced epithelial ovarian cancer diagnosed in Scotland, 64 (59%) had no residual disease following surgery. This is the third consecutive year that the target has been achieved. At NHS Board level, it was a similar pattern with all boards achieving target in each year with the exception of NHS Tayside and NHS Ayrshire & Arran in year 3, although this is due to the small numbers involved in these boards; and NHS Lanarkshire in year 1. However, it should be noted that there was a change to the exclusion criteria after the baseline review in year 1 where patients who delayed primary surgery (following neo adjuvant therapy) were excluded. This may account for some of the differences from year 1 to year 2. 100 QPI 5 - No macroscopic residual disease following surgery for advanced disease (i) by Health Board of Surgery 90 80 70 60 50 40 30 30% 20 10 0 Grampian Highland Orkney Shetland Tayside Western Isles NOSCAN Borders Dumfries & Galloway Fife Lothian SCAN Ayrshire & Forth Valley Greater Lanarkshire WoSCAN Scotland Arran Glasgow & Clyde NOSCAN SCAN WoSCAN Scotland 2013/14 2014/15 2015/16 Target 25
2015/16 Past % Performance NR for NR for NR for NHS Board/Region % Performance Numerator Denominator Numerator Exclusion Denominator 2013/14 2014/15 Grampian 64.7 11 17 3 72.7 71.4 Highland - - - - * Orkney * * * 1 * * Shetland * * * * * Tayside - - - - 80.0 Western Isles * * * * * NOSCAN 60.0 12 20 3 1 73.3 73.7 Borders - - - - - Dumfries & Galloway * * * - - Fife 37.5 3 8 53.3 40.0 Lothian 57.7 15 26 42.5 65.0 SCAN 52.8 19 36 47.5 58.3 Ayrshire & Arran - - - 1 53.3 - Forth Valley * * * 37.5 - Greater Glasgow & Clyde 62.0 31 50 1 4 39.4 63.9 Lanarkshire - - - 27.3 - WoSCAN 62.3 33 53 2 4 40.3 60.0 Scotland 58.7 64 109 5 5 46.9 62.0 Source: Cancer audit - Data not shown due to small numbers * No data matching QPI criteria NHS Greater Glasgow & Clyde commented that in several cases complete cytoreduction could not be achieved and questioned whether this could be improved by having colorectal assistance. Due to this, a new process is in place for seeking colorectal input in advance of surgery where applicable. It is anticipated that this additional input will improve the performance of this QPI further. Due to the small numbers involved in each year, aggregate figures for years 2 and 3 are shown below for reference (year 1 excluded due to the change in exclusion criteria). QPI 5(i) 2 year aggregate figures NHS Board/Region % Performance Numerator Denominator Grampian 67.7 21 31 Highland - - - Orkney * * * Shetland * * * Tayside 57.1 4 7 Western Isles * * * NOSCAN 66.7 26 39 Borders 66.7 4 6 Dumfries & Galloway - - - Fife 38.9 7 18 Lothian 60.9 28 46 SCAN 55.6 40 72 Ayrshire & Arran 40.0 2 5 Forth Valley - - - Greater Glasgow & Clyde 62.8 54 86 Lanarkshire 60.0 3 5 WoSCAN 61.2 60 98 Scotland 60.3 126 209 26
QPI 5(ii): No macroscopic residual disease following surgery for advanced disease residual disease < 1cm. Improved patient outcomes are observed in patients with no visible residual disease following surgical resection. Numerator: Number of patients with advanced epithelial ovarian cancer (FIGO Stage 2 or higher) with macroscopic residual disease < 1cm. Denominator: All patients with advanced epithelial ovarian cancer (FIGO Stage 2 or higher) undergoing surgery. Exclusions: Patients with FIGO Stage 4 disease. Target: 60% The second part of QPI5 looks at the percentage of patients with residual disease < 1cm following surgery. As with QPI 5(i), the performance at national level is above target over the 3 years. There is more variation at NHS Board level but this is largely due to the small numbers involved. 100 QPI 5 - No macroscopic residual disease following surgery for advanced disease (ii) by Health Board of Surgery 90 80 70 60 60% 50 40 30 20 10 0 Grampian Highland Orkney Shetland Tayside Western Isles NOSCAN Borders Dumfries & Galloway Fife Lothian SCAN Ayrshire & Forth Valley Greater Lanarkshire WoSCAN Scotland Arran Glasgow & Clyde NOSCAN SCAN WoSCAN Scotland 2013/14 2014/15 2015/16 Target 27
2015/16 Past % Performance NR for NR for NR for NHS Board/Region % Performance Numerator Denominator Numerator Exclusion Denominator 2013/14 2014/15 Grampian 70.6 12 17 3 72.7 78.6 Highland - - - - * Orkney * * * 1 * * Shetland * * * * * Tayside - - - - 80.0 Western Isles * * * * * NOSCAN 70.0 14 20 3 1 73.3 78.9 Borders - - - - - Dumfries & Galloway * * * - * Fife 87.5 7 8 86.7 81.8 Lothian 76.9 20 26 60.0 66.7 SCAN 77.8 28 36 68.9 72.2 Ayrshire & Arran - - - 1 80.0 - Forth Valley * * * 100.0 - Greater Glasgow & Clyde 72.0 36 50 1 4 75.8 80.6 Lanarkshire - - - 81.8 - WoSCAN 71.7 38 53 2 4 80.6 73.3 Scotland 73.4 80 109 5 5 74.8 74.0 Source: Cancer audit - Data not shown due to small numbers * No data matching QPI criteria At the formal review, it was proposed to remove specification (ii) from this QPI and focus on monitoring no residual disease as in specification (i). An increase in the target for (i) from 30% to 50% was also suggested given the consistently good performance of this QPI. A change to the exclusion criteria from stage 4 to stage 4b was also proposed. Due to the small numbers involved in each year, aggregate figures for years 2 and 3 are shown below for reference (year 1 excluded due to the change in exclusion criteria). QPI 5(ii) 2 year aggregate figures NHS Board/Region % Performance Numerator Denominator Grampian 74.2 23 31 Highland - - - Orkney * * * Shetland * * * Tayside 71.4 5 7 Western Isles * * * NOSCAN 74.4 29 39 Borders 66.7 4 6 Dumfries & Galloway * * * Fife 84.2 16 19 Lothian 72.3 34 47 SCAN 75.0 54 72 Ayrshire & Arran 40.0 2 5 Forth Valley - - - Greater Glasgow & Clyde 75.6 65 86 Lanarkshire 60.0 3 5 WoSCAN 72.4 71 98 Scotland 73.7 154 209 28
QPI 6: Histopathology reports are complete and support clinical decisionmaking Histopathological reporting provides prognostic indicators which inform treatment planning for women diagnosed with epithelial ovarian cancer. Numerator: Number of patients with epithelial ovarian cancer undergoing definitive cytoreductive surgery who have a complete pathology report that contains all data items as defined by the Royal College of Pathologists. Denominator: All patients with epithelial ovarian cancer undergoing definitive cytoreductive surgery. Exclusions: No exclusions Target: 90% Overall in Scotland, there has been a decrease in the percentage of patients whose pathology report is complete from 93% in 2013/14 to 79% in 2015/16. This is largely driven by an equivalent reduction in NHS Greater Glasgow & Clyde which accounts for over 35% of all the patients in this cohort. Generally, though, performance is good across boards with NHS Grampian, NHS Tayside and NHS Lothian achieving target in each year. 100 QPI 6 - Histopathology reports are complete and support clinical decision making by Health Board of Surgery 90 90% 80 70 60 50 40 30 20 10 0 Grampian Highland Orkney Shetland Tayside Western Isles NOSCAN Borders Dumfries & Galloway Fife Lothian SCAN Ayrshire & Forth Valley Greater Lanarkshire WoSCAN Scotland Arran Glasgow & Clyde NOSCAN SCAN WoSCAN Scotland 2013/14 2014/15 2015/16 Target 29
2015/16 Past % Performance NR for NR for NR for NHS Board/Region % Performance Numerator Denominator Numerator Exclusion Denominator 2013/14 2014/15 Grampian 95.5 42 44 100.0 93.5 Highland * * * * - Orkney - - - * * Shetland * * * * * Tayside 100.0 9 9 100.0 100.0 Western Isles * * * * * NOSCAN 94.4 51 54 100.0 95.5 Borders 100.0 7 7 83.3 100.0 Dumfries & Galloway - - - - 100.0 Fife 88.2 15 17 81.0 95.5 Lothian 95.3 41 43 94.2 97.7 SCAN 91.3 63 69 90.4 97.4 Ayrshire & Arran 100.0 6 6 87.5 100.0 Forth Valley * * * 92.3 - Greater Glasgow & Clyde 61.3 65 106 94.4 79.3 Lanarkshire 100.0 5 5 100.0 - WoSCAN 65.0 76 117 93.1 81.6 Scotland 79.2 190 240 93.0 90.0 Source: Cancer audit - Data not shown due to small numbers * No data matching QPI criteria NHS Greater Glasgow & Clyde conducted a review of those patients not meeting target in year 3 and concluded that most patients had delayed surgery i.e. surgery after chemotherapy. In these cases, washings will not be done and pathology cannot stage the disease relevantly. It was, therefore, suggested that patients having delayed surgery should be excluded. Although no changes to the wording of the QPI were proposed at Formal Review, it was agreed to update the notes within the data definitions to specify that washings are not required for patients undergoing delayed primary surgery. 30
QPI 7(i): - Histo/cytological diagnosis prior to starting neo-adjuvant chemotherapy Before commencing neo-adjuvant cytotoxic chemotherapy, women with suspected advanced ovarian cancer should have their diagnosis confirmed by histology or by cytology if histology is not appropriate. Numerator: Number of patients having histo/cytological diagnosis of epithelial ovarian cancer recorded prior to starting chemotherapy. Denominator: All patients with epithelial ovarian cancer undergoing neo-adjuvant chemotherapy. Exclusions: Patients for whom paracentesis, image-guided biopsy or laparoscopy is considered not suitable. Target: 100% Over the 3 reporting years there were 364 patients with epithelial ovarian cancer undergoing neo-adjuvant chemotherapy. In 100% of these cases, the diagnosis was confirmed by histology or cytology prior to starting chemotherapy. 100 QPI 7 Histo/cytological diagnosis prior to starting neo-adjuvant chemotherapy (i) by Health Board of Surgery 100% 90 80 70 60 50 40 30 20 10 0 Grampian Highland Orkney Shetland Tayside Western Isles NOSCAN Borders Dumfries & Galloway Fife Lothian SCAN Ayrshire & Forth Valley Greater Lanarkshire WoSCAN Scotland Arran Glasgow & Clyde NOSCAN SCAN WoSCAN Scotland 2013/14 2014/15 2015/16 Target 31
2015/16 Past % Performance NHS Board/Region % Performance Numerator Denominator NR for Numerator NR for Exclusion NR for Denominator 2013/14 2014/15 Grampian 100.0 12 12 100.0 100.0 Highland 100.0 8 8 100.0 100.0 Orkney * * * * * Shetland - - - - * Tayside 100.0 17 17 - - Western Isles * * * * - NOSCAN 100.0 38 38 100.0 100.0 Borders 100.0 6 6 * * Dumfries & Galloway - - - - 100.0 Fife 100.0 5 5 100.0 100.0 Lothian 100.0 16 16 100.0 100.0 SCAN 100.0 30 30 100.0 100.0 Ayrshire & Arran 100.0 11 11 100.0 100.0 Forth Valley 100.0 11 11 100.0 100.0 Greater Glasgow & Clyde 100.0 25 25 100.0 100.0 Lanarkshire 100.0 11 11 100.0 100.0 WoSCAN 100.0 58 58 100.0 100.0 Scotland 100.0 126 126 100.0 100.0 Source: Cancer audit - Data not shown due to small numbers * No data matching QPI criteria 32
QPI 7(ii): - Histo/cytological diagnosis prior to starting neo-adjuvant chemotherapy - obtained by percutaneous image-guided biopsy or laparoscopy. Before commencing neo-adjuvant cytotoxic chemotherapy, women with suspected advanced ovarian cancer should have their diagnosis confirmed by histology or by cytology if histology is not appropriate. Numerator: Number of patients who have a diagnosis of epithelial ovarian cancer confirmed by histology prior to starting chemotherapy. Denominator: All patients with epithelial ovarian cancer having histo/cytological diagnosis recorded prior to starting neo-adjuvant chemotherapy. Exclusions: No exclusions Target: 80% Specification (ii) of QPI 7 looks at the proportion of those patients having a histological diagnosis prior to starting neo-adjuvant chemotherapy with histological diagnosis obtained by percutaneous image-guided biopsy or laparoscopy. Of the 131 patients in Scotland in 2015/16 in this cohort, 113 (86%) patients had their diagnosis confirmed by histology. This is above the target of 80% and an improvement from 76% in year 1. At network level, both SCAN and WoSCAN showed a similar improving trend but conversely, NOSCAN appear to be decreasing over the same period. 100 QPI 7 Histo/cytological diagnosis prior to starting neo-adjuvant chemotherapy (ii) by Health Board of Surgery 90 80 80% 70 60 50 40 30 20 10 0 Grampian Highland Orkney Shetland Tayside Western Isles NOSCAN Borders Dumfries & Galloway Fife Lothian SCAN Ayrshire & Forth Valley Greater Lanarkshire WoSCAN Scotland Arran Glasgow & Clyde NOSCAN SCAN WoSCAN Scotland 2013/14 2014/15 2015/16 Target 33
2015/16 Past % Performance NR for NR for NR for NHS Board/Region % Performance Numerator Denominator Numerator Exclusion Denominator 2013/14 2014/15 Grampian 66.7 8 12 87.5 73.3 Highland 75.0 6 8 88.9 66.7 Orkney - - - * * Shetland - - - - * Tayside 82.4 14 17 - - Western Isles * * * * - NOSCAN 71.8 28 39 88.9 76.9 Borders 83.3 5 6 * * Dumfries & Galloway - - - - 62.5 Fife 100.0 5 5 100.0 100.0 Lothian 93.8 15 16 76.9 89.5 SCAN 93.3 28 30 83.3 84.8 Ayrshire & Arran 85.7 12 14 66.7 75.0 Forth Valley 100.0 11 11 50.0 57.1 Greater Glasgow & Clyde 92.0 23 25 45.5 81.8 Lanarkshire 91.7 11 12 100.0 100.0 WoSCAN 91.9 57 62 63.5 82.6 Scotland 86.3 113 131 75.7 82.0 Source: Cancer audit - Data not shown due to small numbers * No data matching QPI criteria Several NHS Boards reviewed cases and provided detailed reasons for patients not meeting the QPI, most commonly due to patients receiving cytology only when biopsy was not advised or possible. At the formal review it was proposed to remove specification (i) from this QPI and focus solely on diagnosis confirmed by histology. This will be in place for future reporting of this QPI. 34
QPI 8(i): Delayed primary surgery Delayed primary surgery, after neo-adjuvant chemotherapy for advanced epithelial ovarian cancer (FIGO Stage 3c or 4), should achieve optimal cytoreduction (<1cm). Improved patient outcomes are observed in patients with no visible residual disease following surgical resection. Numerator: Number of patients with advanced epithelial ovarian cancer (FIGO Stage 3c or 4) undergoing delayed primary surgery after neo-adjuvant chemotherapy. Denominator: All patients with advanced epithelial ovarian cancer (FIGO Stage 3c or 4) having neo-adjuvant chemotherapy. Exclusions: No exclusions Target: 75% Since year 1, more than 75% of patients with advanced epithelial ovarian cancer having neoadjuvant chemotherapy had delayed primary surgery, thus achieving the target in the last 2 years. Both SCAN and WoSCAN achieved the target in each of the 3 years. However, NOSCAN have yet to meet the target despite showing a significant improvement from 25% in year 1 to 71% in year 3. There is more variation at NHS Board level but this is largely due to the small numbers involved. 100 QPI 8 - Delayed primary surgery (i) by Health Board of Diagnosis 90 80 70 75% 60 50 40 30 20 10 0 Grampian Highland Orkney Shetland Tayside Western Isles NOSCAN Borders Dumfries & Galloway Fife Lothian SCAN Ayrshire & Forth Valley Greater Lanarkshire WoSCAN Scotland Arran Glasgow & Clyde NOSCAN SCAN WoSCAN Scotland 2013/14 2014/15 2015/16 Target 35
2015/16 Past % Performance NR for NR for NR for NHS Board/Region % Performance Numerator Denominator Numerator Exclusion Denominator 2013/14 2014/15 Grampian 88.9 8 9 36.4 100.0 Highland - - - 0.0 20.0 Orkney * * * 1 * * Shetland - - - * * Tayside 62.5 5 8 * * Western Isles * * * * * NOSCAN 71.4 15 21 1 25.0 60.0 Borders - - - * * Dumfries & Galloway - - - - 83.3 Fife 60.0 3 5 83.3 100.0 Lothian 100.0 6 6 77.3 88.9 SCAN 77.8 14 18 75.0 90.5 Ayrshire & Arran 75.0 6 8 2 80.0 77.8 Forth Valley 77.8 7 9 57.1 42.9 Greater Glasgow & Clyde 90.5 19 21 1 100.0 95.0 Lanarkshire 72.7 8 11 66.7 88.2 WoSCAN 81.6 40 49 3 79.5 83.0 Scotland 78.4 69 88 4 67.8 82.1 Source: Cancer audit - Data not shown due to small numbers * No data matching QPI criteria In NHS Lanarkshire, all patients not meeting this QPI were reviewed and valid clinical reasons were provided. A common reason - also noted by other NHS Boards (NHS Dumfries & Galloway, NHS Fife, NHS Lothian and NHS Highland) was patients being unsuitable for surgery due to disease progression while on chemotherapy. In other cases, across several NHS Boards, tumours were found to be too extensive to achieve optimal resection. Due to the small numbers involved in each year, the 3 year aggregate figures are shown below for reference. QPI 8(i) 3 year aggregate figures NHS Board/Region % Performance Numerator Denominator Grampian 68.0 17 25 Highland 23.1 3 13 Orkney * * * Shetland - - - Tayside 62.5 5 8 Western Isles * * * NOSCAN 53.2 25 47 Borders - - - Dumfries & Galloway 69.2 9 13 Fife 82.4 14 17 Lothian 83.8 31 37 SCAN 80.3 57 71 Ayrshire & Arran 77.3 17 22 Forth Valley 60.9 14 23 Greater Glasgow & Clyde 94.6 53 56 Lanarkshire 77.5 31 40 WoSCAN 81.6 115 141 Scotland 76.1 197 259 36
QPI 8(ii): Delayed primary surgery following neo-adjuvant chemotherapy Delayed primary surgery, after neo-adjuvant chemotherapy for advanced epithelial ovarian cancer (FIGO Stage 3c or 4), should achieve optimal cytoreduction (<1cm). Improved patient outcomes are observed in patients with no visible residual disease following surgical resection. Numerator: Number of patients with advanced epithelial ovarian cancer (FIGO Stage 3c or 4) undergoing delayed primary surgery with residual disease <1cm. Denominator: All patients with advanced epithelial ovarian cancer (FIGO Stage 3c or 4) undergoing delayed primary surgery after neo-adjuvant chemotherapy. Exclusions: No exclusions Target: 65% Specification (ii) of QPI8 looks at the percentage of patients undergoing delayed primary surgery after neo-adjuvant chemotherapy with optimal cytoreduction (i.e. residual disease < 1cm). The target of >65% was achieved at a national level in each of the three reporting years, although there is a decreasing trend across the period. This trend is largely due to an equivalent decrease observed in WoSCAN from 94% in year 1 to 73% in year 3, although still above target. 100 QPI 8 - Delayed primary surgery (ii) by Health Board of Diagnosis 90 80 70 60 65% 50 40 30 20 10 0 Grampian Highland Orkney Shetland Tayside Western Isles NOSCAN Borders Dumfries & Galloway Fife Lothian SCAN Ayrshire & Forth Valley Greater Lanarkshire WoSCAN Scotland Arran Glasgow & Clyde NOSCAN SCAN WoSCAN Scotland 2013/14 2014/15 2015/16 Target 37
2015/16 Past % Performance NR for NR for NR for NHS Board/Region % Performance Numerator Denominator Numerator Exclusion Denominator 2013/14 2014/15 Grampian 87.5 7 8 1-60.0 Highland - - - * - Orkney * * * * * Shetland * * * * * Tayside 60.0 3 5 * * Western Isles * * * * * NOSCAN 80.0 12 15 1-66.7 Borders - - - * * Dumfries & Galloway - - - 1-80.0 Fife - - - 100.0 100.0 Lothian 83.3 5 6 82.4 100.0 SCAN 78.6 11 14 1 87.5 94.7 Ayrshire & Arran 50.0 3 6 1 2-85.7 Forth Valley 71.4 5 7 - - Greater Glasgow & Clyde 73.7 14 19 1 93.3 84.2 Lanarkshire 87.5 7 8 100.0 66.7 WoSCAN 72.5 29 40 1 3 93.5 77.3 Scotland 75.4 52 69 3 3 89.8 81.2 Source: Cancer audit - Data not shown due to small numbers * No data matching QPI criteria All cases not meeting the target were reviewed across the NHS Boards and valid clinical reasons were provided. The formal review group proposed to change this indicator to measure no residual disease rather than <1cm. Due to the small numbers involved in each year, the 3 year aggregate figures are shown below for reference. QPI 8(ii) 3 year aggregate figures NHS Board/Region % Performance Numerator Denominator Grampian 76.5 13 17 Highland - - - Orkney * * * Shetland * * * Tayside 60.0 3 5 Western Isles * * * NOSCAN 76.0 19 25 Borders - - - Dumfries & Galloway 77.8 7 9 Fife 92.9 13 14 Lothian 87.1 27 31 SCAN 87.7 50 57 Ayrshire & Arran 70.6 12 17 Forth Valley 78.6 11 14 Greater Glasgow & Clyde 83.0 44 53 Lanarkshire 80.6 25 31 WoSCAN 80.0 92 115 Scotland 81.7 161 197 38
QPI 9: First-line Chemotherapy First line chemotherapy treatment of epithelial ovarian cancer should include a platinum agent, either in combination or as a single agent. Numerator: Number of epithelial ovarian cancer patients who receive chemotherapy treatment involving either paclitaxel in combination with a platinum-based compound or carboplatin only. Denominator: All epithelial ovarian cancer patients Exclusions: Patients with low-grade serous disease. Patients with FIGO stage 1a or 1b, low grade (G1) disease. Patients with Stage 1a clear cell tumours. Patients who decline chemotherapy treatment. Target: 90% Of the 415 patients with epithelial ovarian cancer in Scotland in 2015/16, 84% (349 patients) received first line chemotherapy including a platinum agent. This is a slight improvement over the previous two years but still below the target of 90%. Excluding those Boards with small numbers, only NHS Borders and NHS Forth Valley achieved the target in year 3. 100 QPI 9 - First-line Chemotherapy by Health Board of Diagnosis 90 90% 80 70 60 50 40 30 20 10 0 Grampian Highland Orkney Shetland Tayside Western Isles NOSCAN Borders Dumfries & Galloway Fife Lothian SCAN Ayrshire & Forth Valley Greater Lanarkshire WoSCAN Scotland Arran Glasgow & Clyde NOSCAN SCAN WoSCAN Scotland 2013/14 2014/15 2015/16 Target 39