1. South West Public Health Observatory South West Regional Public Health Group Impact of urological cancer, by stage at diagnosis Sean McPhail 1, David Gillatt 2, Brian Cottier 3, Julia Verne 1 1: South West Public Health Observatory 2: British Urological Institute 3: National Cancer Surveillance Analysis Team sean.mcphail@swpho.nhs.uk

2. South West Public Health Observatory South West Regional Public Health Group Aim of this work Overview of impact of an urological cancer diagnosis –Procedures –Bed-days

3. South West Public Health Observatory South West Regional Public Health Group Method Combine registry, BAUS and HES data for England Define cohort, diagnosed 2001-2003 with Prostate, Bladder, or Kidney Cancer (C61, C67, C64) Examine 3 years HES data either side of time of diagnosis All patientsHES PatientsStaged nn%n% Prostate8222754977691534419 Bladder257212114982598423 Kidney137311079579214516

4. South West Public Health Observatory South West Regional Public Health Group Analytical considerations 2007/08 HES clinical coding data 16.5% inaccurate 1 –“60% of episodes had no errors” Error = f (HES coding, inpatients only, matching, staging) Duplicates ≈ 10-20% of episodes Episodes vs bed-days vs spells How to normalise? 1: PbR Data Assurance Framework 2007/08, Audit Comission

5. South West Public Health Observatory South West Regional Public Health Group Bed-days by time relative to diagnosis

6. South West Public Health Observatory South West Regional Public Health Group Bed-days by broad treatment category Urinary Unspecified Soft Tissue Misc. Skeleton Digestive

7. South West Public Health Observatory South West Regional Public Health Group Episodes by broad treatment category Urinary Unspecified Soft Tissue Misc. Digestive

8. South West Public Health Observatory South West Regional Public Health Group Bed-days by broad diagnosis category Cancer Heart Digestive Male Genital Female Genital

9. South West Public Health Observatory South West Regional Public Health Group Episodes by stage and cancer type

10. South West Public Health Observatory South West Regional Public Health Group Bed-days by stage and cancer type

11. South West Public Health Observatory South West Regional Public Health Group Bladder cancer procedural breakdown

12. South West Public Health Observatory South West Regional Public Health Group Bladder cancer breakdown by stage

13. South West Public Health Observatory South West Regional Public Health Group Quantifying workload by stage Bed-days per staged patient (3 years) Procedures per staged patient (3 years): Bladder cancer IIIIIIIV Cystectomy0.070.140.230.19 Endoscopic diagnosis0.830.590.480.47 Extirpation of lesion of bladder0.960.710.680.63 All urinary procedures2.251.741.641.48 All unspecified procedures0.280.570.781.25

14. South West Public Health Observatory South West Regional Public Health Group Conclusions With some caveats we can quantify workload using linked HES data This demonstrates real difference between cancer types (bladder > kidney > prostate) Within this the number of procedures and bed-days show complex dependence on stage Further work needed to isolate effect of care prior to death, and ‘background’ morbidity

15. South West Public Health Observatory South West Regional Public Health Group Thank you sean.mcphail@swpho.nhs.uk