Improving Cancer Outcomes in Camden Dr Lucia Grun 19 March 2014

International Cancer Benchmarking Partnership: 5 year relative survival, patients diagnosed : Coleman et al, Lancet 2011

CancerLate stage five year relative survival Early stage five year relative survival Breast13% (IV)92% (I) Lung – Non-small cell2-13% (4)58-73% (1A) Colorectal6.6% (Dukes D)93.2% (Dukes A) Five year survival of common cancers diagnosed Early versus late

Camden-specific statistics… Directly standardised mortality rate aged under 75 for all cancers, Camden, Source: Health and Social Care Information Centre, 2013, NB data for are provisional at the time of publication. 5

Camden-specific statistics… The reduction in Camden’s cancer rates has been faster over the past 10 years (27%) than England (22%) or London (25%) May relate to greater than average reduction in numbers of smokers in Camden In Camden, a higher proportion of people are diagnosed at stage 1 (34%) compared to neighbouring boroughs and the London average. Camden also has a significantly higher proportion of cancers diagnosed at stage 4 (late) compared to the London average Camden Joint Strategic Needs Assessment 2013, Camden Council and-health/health-in-camden/joint-strategic-needs-assessment-2012/chapter-16-cancer.en?page=3 6

National Patient Experience Survey for all cancers Question 64: Practice staff definitely did everything they could to support patient Data Source: National Cancer Patient Experience survey 7

Improving Early Diagnosis &Population Awareness of Cancer in Camden CASE STUDIES Detailed primary and secondary care audit of patient samples AWARENESS CAMPAIGN Local community groups delivering education A&E AUDIT Case studies of diagnoses through unplanned routes PRIMARY CARE ACCESS IMPROVEMENTS INCREASED DIRECT ACCESS TO DIAGNOSTICS PARTNERSHIP WORKING Secondary care specialists with primary care PRACTICE LEVEL DATA Cancer incidence and diagnosis information GP EDUCATION Practice visits, reference materials and seminars 3 year funded project Camden CCG and London Cancer Delivered through other workstreams

Improving outcomes for Camden patients Improve earlier diagnosis of cancer Developing educational opportunities o Online learning package o Integrate results of recent GP questionnaire Linking into national awareness campaigns Reflection on current practice through various methods Best Commissioning Pathways from NHS England Improve communication Interface between primary and secondary care Facilitate connections between practices and CCG London Cancer as a way to support this Improve pathways for patients who present late Learning from the A&E Audit

Encourage stronger links into national awareness campaigns o Awareness of key messages o Available leaflets and promotion in practices Access to appointments o Patient perceptions Uptake in screening programmes o Cervical o Bowel o Breast Earlier Diagnosis – Practice based

Education of reception staff Appropriate use of 2ww referral between primary and secondary care Creating a low risk but not no risk culture Earlier Diagnosis - Communication

Earlier Diagnosis - Reflection Significant event analysis Audit of past cancer diagnoses o Understand patient journey and route to diagnosis o Upcoming audit Sharing learning within practices and localities o Best practice and insights across Camden Using practice profiles o Available at today’s event MacMillan Risk Assessment Tools

Best Practice Pathways for early detection

Numbers of ovarian cancers detected in a theoretical cohort of 100,000 with symptoms consistent with ovarian cancer presenting to primary care Assumed prevalence of undiagnosed ovarian cancer is 0.23% in women with such symptoms- total numbers of ovarian cancer cases is 230 Source: Transforming Cancer Services for London, Best Practice Commissioning Pathway for the early detection of ovarian cancer, NHS England