National Prostate Cancer Audit Julie Nossiter, Project Manager Clinical Effectiveness Unit – Royal College of Surgeons of England Prospective audit development

Introduction Prospective audit designed to address two key concerns: The management of men with low-risk disease – Are patients being over-treated that could be appropriately managed by active surveillance? Use of multimodality therapy * for men with high-risk localised or locally advanced prostate cancer – Are these patients being under-treated? *hormones and external beam radiotherapy; surgery followed by adjuvant or early salvage radiotherapy

Prospective audit Data collection started on the 1 st April 2014 in England: – Characteristics of all newly diagnosed men, how their cancer was detected & the referral pathway – Crucial steps in the diagnostic & staging process – The planning of initial treatment & initial treatments given NPCA will also systematically measure the functional impact of radical therapies on patients’ lives (PROMs/PREMs) – 18 months’ after diagnosis Provide key information on current practice and outcomes: – Early complications, longer term survival & quality of life – Compared with NICE Quality Standards – Generate QPIs

Design of the NPCA MDS: key principles All men with newly diagnosed prostate cancer Data on their diagnosis, staging and initial treatment should be collected during the initial phase of management and available at meetings of the MDT – ‘All patients with a new diagnosis of PC should be discussed at a MDT meeting’ NICE 2002 The burden of data collection on staff and patients should be kept to a minimum The audit data items should be available soon after they are generated in clinical practice

A new generation of national cancer audit Key characteristics of NPCA prospective audit: – based on Cancer Outcomes and Services dataset (COSD) items as much as possible – National Cancer Registration Service (NCRS) is data collection partner Developed ‘minimum dataset (MDS)’ – Project team in consultation with stakeholders – Utilised COSD items, BAUS & created NEW items where appropriate – 50 data items in total (now 49 – 2xCOSD items removed) – only 20 new data items (now 21)

NPCA contact database developed & updated – Communication with trust teams about the audit NPCA Prospective Audit Information Package – Detailed data set specification – Data dictionary & guidance document – Summary handout & FAQ MDT system suppliers – 50% of trusts use Somerset, 25% InfoFlex, 25% ‘Other’ – Worked with Somerset and Infoflex to implement within systems NCRS regional offices – Coordination of CG approval & distribution of NPCA Information Package (also – Help-desk function for trusts – Accept test extracts as local IT teams upgrade MDT systems MDS implementation: England

Mechanism for collection & submission of data for the NPCA mirrors COSD Frequency of data submission is monthly by designated dates post diagnosis/treatment, e.g: November 2014 data by 6 th January 2015 December 2014 data by 5 th February 2015 NPCA data is subsequently exported from MDT software systems and submitted to local NCRS offices along with routine COSD submission It was anticipated that it may take a few months to fully implement appropriate mechanisms for data collection & to align with COSD submission schedule Possible to plug data gaps at a later submission Participation has increased month on month Update from Regina, NCRS including launch of monthly Quality Reports (data completeness) Collection & submission of data: England

Schematic of NPCA data collation

Included in NHS Wales National Clinical Audit and Outcome Review plan – Participation is mandated Mechanism for data collection & submission is currently being developed NHS Wales Information Service are developing software updates to the national Canisc system – Mapping NPCA dataset NPCA has received confirmation that the data collection process in Wales will start in April 2015 – NPCA will work with colleagues in Wales during implementation of the MDS & dissemination of the necessary guidance Collection & submission of data: Wales

NPCA Prospective Audit MDS MDS 1. all newly diagnosed men with PC during MDT meeting (s) to discuss initial phase of treatment – more detail and data item change in the following slides MDS 2. all men with PC who have undergone radical prostatectomy – Paul will explore in more detail and explain data item changes MDS 3. all men with PC for whom external beam radiotherapy or brachytherapy +/- androgen deprivation therapy are planned – Ajay will explain rationale behind collection of planned items and propose mechanism for data collection

MDS 1: introduction 9 routinely collected mandated COSD items: patient identity & demographic details; NHS Trust/MDT/Consultant Collect clinical data on the patient, their cancer and their initial treatment plan (summary handout in delegate pack) – 20 clinical items in total : 11 in COSD, 9 new items including 2 in RCPath

MDS 1: Case-mix adjustment NPCA will take account of differences in mix of patients between providers – Age & ethnicity, socioeconomic status, overall physical condition, comorbidity and pre-existing urinary symptoms

MDS 1: Source of referral Approx. 25% patients first diagnosed with cancer after an emergency hospital admission – Early detection is an important determinant of treatment outcome NPCA will determine variation in the way PC is diagnosed – Geographical variation, relationship with disease stage at presentation, treatment allocation and ultimately outcomes

MDS 1: Risk Stratification NPCA will collect information on a patient’s definitive diagnosis of PC – Biopsy type, biopsy histology, D’Amico risk stratification

MDS 1:Multiparametric MRI NPCA will determine whether men undergo mpMRI before prostate biopsy as an initial step in the diagnostic pathway

MDS 1: Patient pathways NPCA will determine the patient pathway following diagnosis – type/s of clinical specialist men are seen by and in what setting

MDS 1 data item change: Planned treatments ‘Planned prostate cancer treatment’ was captured during MDT prior to discussion with patient – ‘back mapped’ to COSD item ‘Planned treatments’ – ‘all options’ captured = limited utility NPCA will collect: Planned Prostate Cancer Treatment agreed with the Patient – Treatment plan agreed with the patient – only one plan (may be a combination of radiotherapy and hormones)

Thank You