1. COSD Roadshow Local Issues and Challenges Hilary Wilderspin; London Cancer Alliance 13 th April 2015 v2

2. Cancer in London Primary cause of death in 2013 Wide variation in incidence, mortality and survival by tumour type Important to understand data at this level of granularity Picture in London generally better than the rest of England as the population is younger, BUT Wide variation in incidence, mortality at CCG level Awaiting 1 year survival data for 2012 new diagnoses for more accurate assessment of survival rates

3. Primary cause of death in London – by disease group – ONS data 2013 Causes of deathNumbers All neoplasms (C00-97)13780 Diseases of circulatory system13551 Diseases of the respiratory system (J00-99)6647 Mental and behavioural disorders (F00-99)3355 Diseases of digestive system2138 Diseases of nervous systems1855 Accidents1852 Other/unknown/external causes1360 Diseases of the genitourinary system958 Endocrine, nutritional and metabolic diseases737 Infectious and parasitic diseases (A00-B99)553 In situ neoplams and diseases of blood (D00-89)432 Diseases of musculoskeltal system and connective tissue (M00-99)362 Total deaths47580

4. Cancer deaths by tumour type – ONS data 2013 Cause of DeathNumbers Stomach and digestive organs (C15-26)3842 Respiratory and intrathoracic organs (C30-39)3065 Haematology (C81-96)1143 Breast (C50)1071 Unknown primaries (C76-80)939 Male genital organs (C60-63)888 Gynaecology (C51-58)682 Urinary tract (C64-68)673 Head and Neck (C00-14, C30-32)497 Eye/Brain/CNS (C69-72)376 Sarcoma (C45-49)286 Skin (C43-44)221 Endocrine (C73-75)77 Other cancers20 All neoplasms (C00-97)13780

5. Comparative incidence and mortality Areas where London has higher rates of age-standardised incidence (2008- 2010) – 95% confidence interval Male – Larynx, Liver, Anal Canal and Anus, Sarcoma, Prostate, Multiple Myeloma Female – Thyroid, Liver, Multiple Myeloma Areas where London has higher rates of age-standardised mortality (2009-2011) – 95% confidence interval Male – Larynx, Liver Female – Liver, Uterus

6. Incidence of lung (incl. trachea & bronchus) cancer, age-standardised rate per 100,000 European Standard Population, by NHS Clinical Commissioning Groups (CCGs) in London Cancer Alliance and London Cancer, 2010 to 2012 6 Incidence of lung (incl. trachea & bronchus) cancer (ICD-10: C33-C34) B & D = Barking & Dagenham, C & H = City & Hackney, H & F = Hammersmith & Fulham, H = Hillingdon, I = Islington, K & C = West London (Kensington & Chelsea), K = Kingston, L = Lambeth, R = Richmond, S = Southwark, TH = Tower Hamlets, W = Central London (Westminster), WF = Waltham Forest London Cancer London Cancer Alliance Source: Public Health England © Crown Copyright and database right. 2014. All rights reserved. Ordnance Survey Licence number 100016969

7. Incidence of breast cancer, age-standardised rate per 100,000 European Standard Population, by NHS Clinical Commissioning Groups (CCGs) in London Cancer Alliance and London Cancer, 2010 to 2012 7Incidence of breast cancer (ICD-10: C50) B & D = Barking & Dagenham, C & H = City & Hackney, H & F = Hammersmith & Fulham, H = Hillingdon, I = Islington, K & C = West London (Kensington & Chelsea), K = Kingston, L = Lambeth, R = Richmond, S = Southwark, TH = Tower Hamlets, W = Central London (Westminster), WF = Waltham Forest London Cancer London Cancer Alliance Source: Public Health England © Crown Copyright and database right. 2014. All rights reserved. Ordnance Survey Licence number 100016969

8. The importance of COSD COSD is the source of data being used for national outcome measures; survival by stage, SACT mortality national audits including clinician level data; prostate, lung, ? others to follow clinical indicators for each tumour type use in peer review assessments which will be available to the CQC Therefore, improving cancer data quality is critical Increasing external focus on cancer information, especially in context of new cancer strategy Consequences for organisational reputation with patients, commissioners, charities etc.

9. Emerging analyses – NCIN/London KIT 1 year survival by stage – pan London/ICS, not at CCG level 30,60, 90 day post chemotherapy mortality - anonymised Routes to diagnosis - update Stage at diagnosis – COSD portal Additional service profiles in Haematology, HPB, Skin, Urology and Brain/CNS Clinical Headline Indicators/COSD level 4 conformance

10. Examples of LCA comparative analyses Best practice pathway compliance metrics – use of HES and linked data items from COSD Cancer Waiting Times Treatments e.g. immediate breast reconstructions, resection rates, laparoscopic v open surgery rates, door to needle time for neutropenic sepsis National Cancer Patient Experience Survey Systemic Anti Cancer Therapy datasets – regimen by tumour type by provider Data quality monitoring – COSD, SACT

11. Data Quality Challenge COSD is a major challenge for providers and for a wide range of their staff – MDTs, Pathology, Radiology, Chemotherapy, Radiotherapy Systems, processes and people – all have to be aligned Requires senior leadership commitment There is not a magic bullet Whilst there has been significant improvement in London, particularly in staging data completeness, but there is still a long way to go

12. 1. Staging completeness by region Source – COSD portal level 2 reports Numerator – Denominator – L2.1i – Number of Cancers which at Stage-able Numerator – L2.1j – Number of Cancers with Full Stage at Diagnosis Benchmark set – 70% Area Number of cases diagnosis Number stageabl e Number with full stage % stageable fully staged London Cancer Alliance27522238931619267.8% Merseyside and Cheshire18325163281102467.5% London Cancer1561013756873463.5% Greater Manchester, Lancashire & South Cumbria38234343741950256.7% Wessex1638315161840055.4% South West52000447722093346.8% South East Coast38208347441575745.4% Yorkshire And The Humber44935385981512739.2% East of England43584390621521639.0% West Midlands39391346271292037.3% East Midlands2376621776714032.8% North East, North Cumbria, And North Yorks3112726578693426.1% Thames Valley72696685154723.1% England Overall39635435035415942645.5% Collated by Stephen Scott & Salma Abadi stephenscott@nhs.netstephenscott@nhs.net In strictest confidence – For NHS internal use only

13. 2. Basis of diagnosis completeness by region Source – COSD portal level 2 reports Numerator – Denominator – L2.1a – Number of Cancers Diagnosed Numerator – L2.1d – Number of Cancers with Basis of Diagnosis Benchmark set – 70% Area Number of cases diagnosis Number with basis of diagnosis % diagnosed with basis of diagnosis Merseyside and Cheshire183251786798% North East, North Cumbria, And North Yorks311273020397% East of England435844048993% Yorkshire And The Humber449354146592% Wessex163831500492% Greater Manchester, Lancashire & South Cumbria382343478691% South West520004701990% West Midlands393913504789% Thames Valley7269634887% South East Coast382083160683% London Cancer156101241580% East Midlands237661840077% London Cancer Alliance275221904669% England Overall39635434969588% Collated by Stephen Scott & Salma Abadi stephenscott@nhs.netstephenscott@nhs.net In strictest confidence – For NHS internal use only

14. 5. Proportion of cases diagnosed, with CNS code submitted Source – COSD portal level 2 reports Numerator – Denominator – L2.1a– Numbers of Cancers Diagnosed Numerator – L2.1f – Number of Cancers with a CNS indication Code Submitted Benchmark set – 70% Collated by Stephen Scott & Salma Abadi stephenscott@nhs.netstephenscott@nhs.net In strictest confidence – For NHS internal use only Area Number of cases diagnosis Number of cases with CNS code sumitted % of cases with CNS code submitted North East, North Cumbria, And North Yorks311271420046% East of England435841719039% Thames Valley7269277838% Merseyside and Cheshire18325673837% Wessex16383571635% West Midlands393911181330% Yorkshire And The Humber449351301629% London Cancer Alliance27522780028% Greater Manchester, Lancashire & South Cumbria382341075828% South East Coast38208820121% South West52000922118% London Cancer15610265417% East Midlands2376619688% England Overall39635411205328%

15. Challenges Providers Ensuring high quality cancer data capture and reporting Greater transparency and granularity of published data e.g. provider level outcomes, clinician level outcomes Commissioners Develop understanding of cancer data and analysis for their population - not just cancer waiting times Need to understand services at pathway and tumour level to improve services and outcomes Public Health England High demand for data – ICSs and TCST Timely access and feedback to clinical teams and continuing data improvement work