Healthy London Partnership Transforming cancer services team for London Tumour Staging in London

Objectives Tumour Staging in London To determine how tumour staging varies across London and over time, and output maps of the findings To determine how ethnicity varies across London and over time, and output maps of the findings To compare ethnicity coding between CAS and HES

Tumour group categories: Any malignant tumour (excludes C44) Methodology Technical Details Cancers diagnosed in London and West Essex during 2012 to 2014 were extracted from PHE’s Cancer Analysis System Tumour group categories: Any malignant tumour (excludes C44) Site-specific tumours: Breast (C50) Lung (C34) Prostate (C61) Colorectal (C18, C19, C20) Findings were then mapped in ArcGIS First, let’s go into the methodology of the tumour staging analysis. Data was extracted from Public Health England’s Cancer Analysis System. This was comprised of cancers diagnosed in London and West Ess-ex between 2012 to 2014 The tumour records were then categorised into the following groups: Any malignant tumour (excluding non-melanoma skin cancer) And site-specific tumour groups based on the Public Health Outcomes Framework definitions For the purposes of this presentation, I will be showing findings of the ones in blue: any malignant tumour and lung Finally all findings were mapped into ArcGIS

Tumour records for diagnosis years 2012, 2013 & 2014 (n=103,454) Methodology Descriptives – Any Malignant Tumour Tumour records for diagnosis years 2012, 2013 & 2014 (n=103,454) Diagnosis year 2012 (n=32,979) Diagnosis year 2013 (n=34,993) Diagnosis year 2014 (n=35,482) Here’s just a quick description of tumour records extracted for any malignant tumour

Tumour records for diagnosis years 2012, 2013 & 2014 (n=12,534) Methodology Descriptives – Lung (C34) Tumour records for diagnosis years 2012, 2013 & 2014 (n=12,534) Diagnosis year 2012 (n=4,158) Diagnosis year 2013 (n=4,212) Diagnosis year 2014 (n=4,164) And here are the tumour record numbers for lung only

Total tumour records for a CCG within a diagnosis year Methodology Proportion of Tumours (Unadjusted) – Any Malignant Tumour Stage 1 Stage 2 Stage 3 Stage 4 Unknown/ Other Total tumour records for a CCG within a diagnosis year To determine the proportions of tumours by staging, first the total number of tumour records for a CCG within a diagnosis year was determined. Then the total was broken down into the stage categories. So, for example, the number of tumours in Stage 1 was divided by the total number of tumours in that CCG to get the proportion.

Total tumour records for a CCG within a diagnosis year Methodology Proportion of Tumours (Unadjusted) – Lung (C34) Early Stage (1 to 2) Advanced Stage (3 to 4) Unknown/ Other Total tumour records for a CCG within a diagnosis year The same idea applies to lung, but this time the stage groupings were different. This is because of suppressed findings, so collapse the stages together

Stage over Time: Any Malignant Tumour Now I will present findings of stage over time for any malignant tumour

Results Stage 1 – Any Malignant Tumour 2012 2013 2014 We’ll see over the next few slides that there was overall an increase in staging over the diagnosis years. Also, after taking the differences in proportions for each stage between 2012 and 2014, the greatest difference, on average, was apparent with Stage 1 vs. the other stages. The mean difference in proportions was 7%.

Results Stage 2 – Any Malignant Tumour 2012 2013 2014 We’ll see over the next few slides that there was overall an increase in staging over the diagnosis years. Also, after taking the differences in proportions for each stage between 2012 and 2014, the greatest difference, on average, was apparent with Stage 1 vs. the other stages. The mean difference in proportions was 7%.

Results Stage 3 – Any Malignant Tumour 2012 2013 2014 We’ll see over the next few slides that there was overall an increase in staging over the diagnosis years. Also, after taking the differences in proportions for each stage between 2012 and 2014, the greatest difference, on average, was apparent with Stage 1 vs. the other stages. The mean difference in proportions was 7%.

Results Stage 4 – Any Malignant Tumour 2012 2013 2014 We’ll see over the next few slides that there was overall an increase in staging over the diagnosis years. Also, after taking the differences in proportions for each stage between 2012 and 2014, the greatest difference, on average, was apparent with Stage 1 vs. the other stages. The mean difference in proportions was 7%.

Results Unknown/Other – Lung 2012 2013 2014

Stage Over Time: Lung (C34)

Results Early Stage (1 to 2) – Lung (C34) 2012 2013 2014

Results Advanced Stage (3 to 4) – Lung (C34) 2012 2013 2014

Results Unknown/Other – Lung (C34) 2012 2013 2014

Stage Over Time: Breast (C50)

Results Early (Stage 1 & 2) – Breast 2012 2013 2014

Results Advanced (Stage 3 & 4) – Breast 2012 2013 2014

Results Unknown/Other – Breast 2012 2013 2014

Stage Over Time: Colorectal (C18, C19, C20)

Results Early (Stage 1 & 2) – Colorectal 2012 2013 2014

Results Advanced (Stage 3 & 4) – Colorectal 2012 2013 2014

Results Unknown/Other - Colorectal 2012 2013 2014

Stage Over Time: Prostate (C61)

Results Early (Stage 1 & 2) – Prostate 2012 2013 2014

Results Advanced (Stage 3 & 4) – Prostate 2012 2013 2014

Results Unknown/Other – Prostate 2012 2013 2014

Summary Findings Any malignant tumour Increase in the proportion of tumours for each stage Seems to be predominantly driven by decrease Unknown/Other, which suggests an increase in data quality (better staging) Stage 1 saw a greater increase compared to Stages 2 to 4 Suggests improved early diagnosis Need to confirm with statistical testing Lung Increase in the proportion of tumours for early stage for most CCGs Consistent for advanced stage Unknown/Other also seems to be decreasing

Thank you! Any questions?