1. Alfredo Addeo Lung NSSG 15th November 2016
30 days SACT UK
Alfredo Addeo
Lung NSSG 15th November 2016

2. Background
Cancer chemotherapy has been provided in the NHS for decades
Accurate, timely and complete data collection is now seen as a priority and this can be assisted by e-prescribing systems
The introduction of the Systemic Anti-Cancer Therapy (SACT) Information Standard (ISB 1533)
Collection and submission of SACT data is specifically incorporated in the England NHS Standard Contract
Cancer chemotherapy has been provided in the NHS for decades
But until recently we have had no way of looking at the national picture in detail.
Accurate, timely and complete data collection is now seen as a priority assisted by e-prescribing systems 1
as mentioned in the NCAG (National Chemotherapy Advisory Group) report - Chemotherapy Services in England 2009
This has led to the introduction of the Systemic Anti-Cancer Therapy (SACT) Information Standard,
With the aim of which is to collect all cancer chemotherapy information in the NHS in England,
Collection with began on 1st April 2012 as part of a 2 year implementation phase, formal implementation 1st April 2014.
The submission of SACT data has been included in the NHS standard contract for and is due to be updated for
National Chemotherapy Advisory Group report– Chemotherapy Services in England: Ensuring quality and safety - August 2009
and - subject to revision for

3. SACT dataset applies to:
All organisations providing cancer chemotherapy services in or funded by the NHS in England and includes:
all cancer patients,
adult AND paediatric
acute inpatient, daycase outpatient settings and
delivery in the community;
Includes oral chemotherapy
Covers chemotherapy treatment for:
all solid tumours
haematological malignancies
and includes those in clinical trials
Who does it apply to?
All cancer patients, adult and paediatric, acute inpatient, daycase outpatients, delivery in the community which includes homecare and oral chemotherapy.
It covers treatments for all solid tumours, haematological malignancies and clinical trials.

4. SACT dataset Consists of 6 sections across 42 data items:
Demographics & Consultant
Clinical Status
Programme & Regimen
Cycle
Drug Details
Outcome
Demographics and Consultant:
Patient: NHS No, Date of Birth, Gender, postcode,
GP, consultant and specialty codes
Organisational code of provider
Clinical Status:
Primary Diagnosis, Morphology and stage
Programme and Regimen
Programme No/Line of treatment, Regimen information including dates, Treatment intent, treatment plan, comorbidity, chemo/radiation
Cycle
Cycle number, performance status and associated dates
Drug Details
Drug name, dose, administration route and dates as well as organisational code of provider delivering the drug
Outcome
Date of final treatment, whether the dose has been adjusted, treatment delayed or stopped early, and date of death.

5. Public Health England CKO Principal developers of the SACT
Who?
NCIN (PHE)
Directors
Public Health England CKO
Chief Knowledge Officer
Dr Ken Lloyd and Sue Forsey
Principal developers of the SACT
NCIN
Clinical Information Specialists
CCIG
Chemotherapy Clinical Information Group
Pharmacist Support
Disease Registration
National Director for Disease Registration
SACT
Programme Board
SACT
Programme Manager
SACT
Snr. PH Analyst
SACT
Trainer/Liaison
SACT
Project Manager
SACT
Systems Developer
CIU Core Team
WHO are the Chemotherapy Intelligence Unit (CIU)?
The SACT dataset exists as a direct consequence of the cancer audit work undertaken by Dr Ken Lloyd and Sue Forsey spanning in excess of a decade – Clinical information specialists for NCIN.
The programme has been commissioned by the NCIN and is governed by the Chemotherapy Clinical Information Group – The SACT programme board is supported by oncology pharmacists.
The CIU is composed of a dynamic team of Programme and Project Managers, Clinical information Specialists, Developers and Data Managers, which have achieved the delivery of the SACT dataset
Through intensive engagement with the clinical chemotherapy community.
The CIU has delivered this England wide project, on time, within budget and entirely within the public sector arena.
CIU sits within the disease registration directorate of the chief knowledge officer, in Public Health England.
SACT
Senior Public Health Data Clerk
SACT
Senior Public Health Data Clerk

6. Allows additional scrutiny of clinical decisions
Ineffective drug?
or insufficient dose of effective drug?
The analysis resulting from the SACT dataset will allow additional scrutiny of clinical decisions
by looking at outcomes we can establish the effectiveness of the treatment…..

7. Optimal choice of clinical management
SACT Dataset
young : old
stage : performance status : co-morbidity
age
Clinical status
Optimal choice of clinical management
for desired outcome
benefit
toxicity
stopped early
dose modified
- treatment delayed
Regimen
&
delivery
curative treatment
disease control
symptom control
By establishing the age and clinical status of the patient
Comparing it to the choice of treatment and the corresponding intent,
balance in terms of toxicity we should generate a clear view of what works
BUT – there must be detailed, accurate and comparable regimen recording to allow effective comparison…
recording regimen and detail correctly is critical

8. National SACT data also:
To describe the level and variation of 30 day mortality following SACT on a national level- identified as quality measurement tool
To highlight the potential to use SACT data to monitor and improve cancer patient care and outcomes and enhance the data quality and reporting by trusts to that end
National SACT data

9. National SACT data Published in the Lancet Oncology Sept 2016
Data collected for patients treated between January – December 2014
28,400 women with breast cancer
15,000 patients with lung cancer
NHS began submitting data in April 2012, and it became mandatory in April 2014
This paper + companion report- 1st major output from this data source
National SACT data

10. SACT DATA 2014

11. National SACT data Palliative intent: Curative intent:
Breast – death within 30 days: 7.5%
Lung – 10%
Curative intent:
Breast – 0.3%
Lung – 2.9%
National SACT data

12. England’s 30-day chemotherapy mortality: a measure of quality of care?
despite this initiative to collate national data for cancer chemotherapy, there were significant gaps and deficiencies in the national dataset.
it remains a tragedy that we still cannot get complete national (anonymised) datasets to inform clinicians and patients and to drive real improvements in patient care.
This study sets a standard for what health-care systems should achieve: to routinely record, collate, and report at a national level the negative consequences of medical interventions to improve the quality of health care.

13. Brest Cancer curative Figure 2
Funnel plot of variation in risk-adjusted 30-day mortality in patients with breast cancer given systemic anticancer therapy with curative intent, by hospital trust
Each circle represents a separate hospital trust; blue and red circles represent outliers beyond the 95% and 99·8% confidence interval boundaries that are represented as grey lines. Red line shows national risk-adjusted 30-day mortality rate.

14. NSCLC curative
Figure 4
Funnel plot showing variation in risk-adjusted 30-day mortality in patients with non-small cell lung cancer given systemic anticancer therapy with curative intent, by hospital trust
Each circle represents a separate hospital trust; blue and red circles represent outliers beyond the 95% and 99·8% confidence interval boundaries that are represented as grey lines. Red line shows national risk-adjusted 30-day mortality rate.

15. NSCLC palliative Figure 5
Funnel plot showing variation in risk-adjusted 30-day mortality in patients with non-small cell lung cancer given systemic anticancer therapy with palliative intent, by hospital trust
Each circle represents a separate hospital trust; blue and red circles represent outliers beyond the 95% and 99·8% confidence interval boundaries that are represented as grey lines. Red line shows national risk-adjusted 30-day mortality rate.

16. Summary of 30-day mortality rates in patients with breast or lung cancer by treatment intent
Data are n (%) of total patients by cancer type and treatment intent; and n (%) of deaths occurring within 30 days of systemic anticancer therapy for each of those groups.

17. 30-day mortality rates in patients with lung cancer by morphology and treatment intent
Data are n (%) of total patients by lung cancer type and treatment intent; and n (%) of deaths occurring within 30 days of systemic anticancer therapy for each of those groups. NSCLC=non-small cell lung cancer. SCLC=small cell lung cancer.

18. 1st important insights into 30-day mortality in a large, representative population of patients with breast or lung cancer receiving systemic anticancer therapy in England.
Some trusts having significantly higher rates for early mortality, the reasons require further investigation
Conclusion

19. Media Reaction
1) New Study Finds Chemo Kills 50% of Patients In First 30 Days 2) Landmark Study Shows Half of Cancer Patients are Killed by Chemo — NOT Cancer

20. LIMITATIONS Submission data mandatory only form april 2014.
Possible wrong coding.
SACT number for 2014 much lower than real?

21. National SACT

22. Data being sent to PHE not a reflection of true 30 day mortality
Disparity in number of patients treated compared to national SACT data
Possible improvement with increased clinical engagement.
Conclusions