Northern Oesophago Gastric Cancer Unit MDT data NECN Audit Meeting - - PowerPoint PPT Presentation
Northern Oesophago Gastric Cancer Unit MDT data NECN Audit Meeting November 2014 Methods Patients discussed at weekly Newcastle Multi-disciplinary Team meeting in period January December 2013 Excludes patients discussed by
malignancy of oesophagus, stomach and OGJ.
for public consumption by HQIP on individual surgeon’s outcomes since 2013.
HQIP in November 2014.
No of cases 50 100 150
Newcastle upon Tyne Salford Nottingham Plymouth Bristol Cambridge Leicester Oxford Birmingham Sheffield Middlesbrough Southampton Leeds Coventry Norwich Barts Marsden Guildford Portsmouth Barking Derby
656 826 0% 20% 40% 60% 80% 100% Total New Rediscussions (67 Carlisle)
(104 Carlisle)
443 46 104 63 0% 20% 40% 60% 80% 100% Total
OG Neoplasm Benign Carlisle Other Other incl. – GISTs, HGD, LGD, Surveillance pts, & referred onto another MDT
267 112 64 0% 20% 40% 60% 80% 100% Total
New Staging In-Patients Restage
241 112 94 61 22 12 10
1 2 3 4 5 6 >6
Median discussion: 2
20 40 60 80 100 120 140 160 180 to 30 31-40 41-50 51-60 61-70 71-80 81-90 91 + Female Male
43 23 20 10 5 3 5 10 15 20 25 30 35 40 45 50 1 2 3 4 5 >5
2013 Carlisle Patients (Total 104) Discussed in MDM
20 40 60 80 100 120 140 160 180 Newcastle Northumb'd Sunderland Durham
Gateshead Others Unclass'd 2007 2008 2009 2010 2011 2012 2013 n=450 vs. 324 vs. 408 vs 467 vs 437 vs 463 vs 443 excl Carlisle pts
No action – incl. Benign, Best supportive care & referral onto other MDT’s Friday MDT’s only
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
ACA SCC Small Cell HGD Other
Other incl. – Carcinoma, cancer see on OGJ no path, adenosquam
20 40 60 80 100
Adeno Squamous
Surgery CT + S CRT + S RT CRT
53 69 76 80 83 95 81 68 73 72 85 58 20 40 60 80 100 120 140 160 180 2008 2009 2010 2011 2012 2013
Oesophagectomy Gastrectomy
Completed Incompl. 30 day 90 day Comps 3+ Accordion Oesophagectomy (incl. 2 benign) 97 4 1 3 3% 29 Total Gastrectomy 23 4 5 Subtotal Gastrectomy (incl. 12 benign) 47 1 1 2% 5 Lesser resection (incl. pall proc.) 16 3 19% 1 EMR 49 N/A
n=137 - 2009 n=149 - 2010 n=162 - 2011 n=168 - 2012 n=167 - 2013
30 day or IH
Leioyoma’s excluded, 9
1 adenosquamous excl.
5 10 15 20 25 Tis T0 N1 T1 N0 T1 N1 T1 N2 T2 N0 T2 N1 T2 N2 T3 N0 T3 N1 T3 N2 T3 N3 T4 N0 T4 N1 T4 N2 T4 N3 SCC ACA
Intended Treatment Treatment Change n
Neoadjuvant + Surgery Unfit for surgery 2 Neoadjuvant + Surgery Progression of disease, no surgery 7 Neoadjuvant + Surgery RIP (3 cycles) patient died no surgery 1 Neoadjuvant + Surgery Patient declined surgery in UK (pt had neo-adj and went back home) 1 Surgery Not fit for surgery/patient declined 2 Neoadjuvant + Surgery Shortened chemotherapy due to toxicity 9 Neoadjuvant + Surgery No neoadjuvant given - GFR too low, surgery only 2 Radical Radio Patient - suicide 1 Chemoradiotherapy Toxicity - did not complete chemo or radio 1
7 10 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Screened Recruited
20 40 60 80 100 120 140 160 180 Jan Feb March April May June July August Septemb October Novemb Decemb
2ww 31 day treats 62 day treats 62 day breaches
62 day breaches: 45.5 (2.7%)
2011 1489 2012 1720 2013 1642 200 400 600 800 1000 1200 1400 1600 1800 2008 2009 2010 2011 2012 2013
5 10 15 20 25 30 35 40 45 50 2008 2009 2010 2011 2012 2013