1. Healthy London Partnership
Transforming cancer services team for London
Tumour Staging in London

2. Objectives
Tumour Staging in London
To determine how tumour staging varies across London and over time, and output maps of the findings
To determine how ethnicity varies across London and over time, and output maps of the findings
To compare ethnicity coding between CAS and HES

3. Tumour group categories: Any malignant tumour (excludes C44)
Methodology
Technical Details
Cancers diagnosed in London and West Essex during to 2014 were extracted from PHE’s Cancer Analysis System
Tumour group categories:
Any malignant tumour (excludes C44)
Site-specific tumours:
Breast (C50)
Lung (C34)
Prostate (C61)
Colorectal (C18, C19, C20)
Findings were then mapped in ArcGIS
First, let’s go into the methodology of the tumour staging analysis.
Data was extracted from Public Health England’s Cancer Analysis System. This was comprised of cancers diagnosed in London and West Ess-ex between 2012 to 2014
The tumour records were then categorised into the following groups:
Any malignant tumour (excluding non-melanoma skin cancer)
And site-specific tumour groups based on the Public Health Outcomes Framework definitions
For the purposes of this presentation, I will be showing findings of the ones in blue: any malignant tumour and lung
Finally all findings were mapped into ArcGIS

4. Tumour records for diagnosis years 2012, 2013 & 2014 (n=103,454)
Methodology
Descriptives – Any Malignant Tumour
Tumour records for diagnosis years 2012, 2013 & 2014 (n=103,454)
Diagnosis year 2012 (n=32,979)
Diagnosis year 2013 (n=34,993)
Diagnosis year 2014 (n=35,482)
Here’s just a quick description of tumour records extracted for any malignant tumour

5. Tumour records for diagnosis years 2012, 2013 & 2014 (n=12,534)
Methodology
Descriptives – Lung (C34)
Tumour records for diagnosis years 2012, 2013 & 2014 (n=12,534)
Diagnosis year 2012 (n=4,158)
Diagnosis year 2013 (n=4,212)
Diagnosis year 2014 (n=4,164)
And here are the tumour record numbers for lung only

6. Total tumour records for a CCG within a diagnosis year
Methodology
Proportion of Tumours (Unadjusted) – Any Malignant Tumour
Stage 1
Stage 2
Stage 3
Stage 4
Unknown/ Other
Total tumour records for a CCG within a diagnosis year
To determine the proportions of tumours by staging, first the total number of tumour records for a CCG within a diagnosis year was determined. Then the total was broken down into the stage categories. So, for example, the number of tumours in Stage 1 was divided by the total number of tumours in that CCG to get the proportion.

7. Total tumour records for a CCG within a diagnosis year
Methodology
Proportion of Tumours (Unadjusted) – Lung (C34)
Early Stage (1 to 2)
Advanced Stage (3 to 4)
Unknown/ Other
Total tumour records for a CCG within a diagnosis year
The same idea applies to lung, but this time the stage groupings were different. This is because of suppressed findings, so collapse the stages together

8. Stage over Time: Any Malignant Tumour
Now I will present findings of stage over time for any malignant tumour

9. Results Stage 1 – Any Malignant Tumour 2012 2013 2014
We’ll see over the next few slides that there was overall an increase in staging over the diagnosis years.
Also, after taking the differences in proportions for each stage between 2012 and 2014, the greatest difference, on average, was apparent with Stage 1 vs. the other stages. The mean difference in proportions was 7%.

10. Results Stage 2 – Any Malignant Tumour 2012 2013 2014
We’ll see over the next few slides that there was overall an increase in staging over the diagnosis years.
Also, after taking the differences in proportions for each stage between 2012 and 2014, the greatest difference, on average, was apparent with Stage 1 vs. the other stages. The mean difference in proportions was 7%.

11. Results Stage 3 – Any Malignant Tumour 2012 2013 2014
We’ll see over the next few slides that there was overall an increase in staging over the diagnosis years.
Also, after taking the differences in proportions for each stage between 2012 and 2014, the greatest difference, on average, was apparent with Stage 1 vs. the other stages. The mean difference in proportions was 7%.

12. Results Stage 4 – Any Malignant Tumour 2012 2013 2014
We’ll see over the next few slides that there was overall an increase in staging over the diagnosis years.
Also, after taking the differences in proportions for each stage between 2012 and 2014, the greatest difference, on average, was apparent with Stage 1 vs. the other stages. The mean difference in proportions was 7%.

13. Results
Unknown/Other – Lung
2012
2013
2014

14. Stage Over Time: Lung (C34)

15. Results
Early Stage (1 to 2) – Lung (C34)
2012
2013
2014

16. Results
Advanced Stage (3 to 4) – Lung (C34)
2012
2013
2014

17. Results
Unknown/Other – Lung (C34)
2012
2013
2014

18. Stage Over Time:
Breast (C50)

19. Results
Early (Stage 1 & 2) – Breast
2012
2013
2014

20. Results
Advanced (Stage 3 & 4) – Breast
2012
2013
2014

21. Results
Unknown/Other – Breast
2012
2013
2014

22. Stage Over Time: Colorectal (C18, C19, C20)

23. Results
Early (Stage 1 & 2) – Colorectal
2012
2013
2014

24. Results
Advanced (Stage 3 & 4) – Colorectal
2012
2013
2014

25. Results
Unknown/Other - Colorectal
2012
2013
2014

26. Stage Over Time: Prostate (C61)

27. Results
Early (Stage 1 & 2) – Prostate
2012
2013
2014

28. Results
Advanced (Stage 3 & 4) – Prostate
2012
2013
2014

29. Results
Unknown/Other – Prostate
2012
2013
2014

30. Summary Findings Any malignant tumour
Increase in the proportion of tumours for each stage
Seems to be predominantly driven by decrease Unknown/Other, which suggests an increase in data quality (better staging)
Stage 1 saw a greater increase compared to Stages 2 to 4
Suggests improved early diagnosis
Need to confirm with statistical testing
Lung
Increase in the proportion of tumours for early stage for most CCGs
Consistent for advanced stage
Unknown/Other also seems to be decreasing

31. Thank you! Any questions?