Northern Oesophago-Gastric Cancer Unit MDT meetingNECN Audit day 2012

Helen Jaretzke, Angie Tate, Jon Shenfine, Paula Brookes, Leigh-Anne Phillips , Gillian Robinson, Jonathan Stoddart

Methods

• Patients discussed at Friday Newcastle Multi-disciplinary Team meeting (MDT)

– January 2011 – December 2011

• Excludes: Patients discussed by video-link to Sunderland only

• Prospective data entry onto database - Dendrite

• Intended use: – Local, Regional & National audit – Research

• Data then exported onto Microsoft Excel for analysis

National Audit: Recommendations

Units Contributing to NOGCA Number of Patients

Lancashire and South Cumbria 458Greater Manchester and Cheshire 1,044Merseyside and Cheshire 681Yorkshire 424Humber and Yorkshire Coast 169North Trent 706Pan Birmingham 360Arden 237Mid Trent 724Derby/Burton 286Leics, Northants and Rutland 577Mount Vernon 232West London 289North London 88North East London 476South East London 265South West London 227Peninsula 636Dorset 267Avon, Somerset and Wiltshire 4483 Counties 534Thames Valley 487Central South Coast 684Surrey, West Sussex and Hampshire 211Sussex 310Kent and Medway 430Greater West Midlands 505North of England 1,252Anglia 896Essex 199

Units Contributing to NOGCA Number of Patients

Lancashire and South Cumbria 458Greater Manchester and Cheshire 1,044Merseyside and Cheshire 681Yorkshire 424Humber and Yorkshire Coast 169North Trent 706Pan Birmingham 360Arden 237Mid Trent 724Derby/Burton 286Leics, Northants and Rutland 577Mount Vernon 232West London 289North London 88North East London 476South East London 265South West London 227Peninsula 636Dorset 267Avon, Somerset and Wiltshire 4483 Counties 534Thames Valley 487Central South Coast 684Surrey, West Sussex and Hampshire 211Sussex 310Kent and Medway 430Greater West Midlands 505North of England 1,252Anglia 896Essex 199

North of England

• County Durham and Darlington NHS Foundation Trust

• North Cumbria Acute Hospitals NHS Trust• North Tees and Hartlepool NHS Trust• Northumbria Healthcare NHS Foundation Trust• South Tees Hospitals NHS Foundation Trust• The Newcastle upon Tyne Hospitals NHS Foundation

Trust

Discussions: Central Newcastle MDT

597 847

0% 20% 40% 60% 80% 100%

Total

New Rediscussions

n=1444

incl Carlisle - 87

510 excl Carlisle

New discussions

437 47 87 26

0% 20% 40% 60% 80% 100%

Total

OG Neoplasm Benign Carlisle Other

n=597

+ ca 522

Other incl. – Gists, HGD, LGD, Surveillance pts,

Barrett’s surveillance pts, referred onto another MDT

New OG neoplasm

262 101 74

0% 20% 40% 60% 80% 100%

Total

New Staging In-Patients Restage

n=437

Number of New MDT Discussions

163

9077

4926

15 17

020406080

100120140160180

No. of Discussions

1 2 3 4 5 6 >6N=437

Excl. Carlisle pts

Comparison 2008-2011 multiple discussions

Excl. Carlisle pts

0% 20% 40% 60% 80% 100%

2011

2010

2009

2008

1 2 3 4 5 6 >6

Carlisle Discussions2011 Carlisle Patients (Total 87)

Discussed in MDM

40

11

710

6

13

0

5

10

15

20

25

30

35

40

45

1 2 3 4 5 >5

No. of Times Each Patient Discussed in MDT

No

. o

f P

atie

nts

New referrals to MDT by site0 20 40 60 80 100 120 140

Newcastle

Northumb'd

Sunderland

Durham

S. Tyneside

Gateshead

Others

Unclass'd

2011 2010 2009 2008 2007 n=450 vs. 324 vs. 408 vs 467 vs 437

2011 – excl Carlisle pts – positive cancers only

Intention to treat by site - 2011

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Durham

Northumberland

NUTH

Gateshead

South Tyneside

Sunderland

Total

Curative Palliative No action No action – incl. Best supportive care & referral onto other MDT’s

Friday MDT’s only

Oesophageal Cancer:(2011) Histological subtype

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Histology

ACA SCC Small Cell HGD Other

Other incl. – Carcinoid, Leioyoma

Oesophageal Cancer: Treatment intent by histological subtype

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ACA

SCC

Curative Palliative

Oesophageal cancer: Curative treatment intent

37

10

0

13

6

0

4

2

0

3

0

2

0 10 20 30 40 50 60

ACA

SCC

Other

NA+Sx Sx Alone RT CRT R & Sx EMR

Resections

53

69

76

80

81

68

73

72

0 20 40 60 80 100 120 140 160

2008

2009

2010

2011

Oesophagectomy Gastrectomy

Resections breakdown - 201150

64

70

76

1

1

4

2

1

34

15

24

27

42

48

43

42

1

4

1

5

0

1

10

8

0 20 40 60 80

2008

2009

2010

2011

STO 3 Stage Lap + Thoracotomy

TG STG Wedge/ Partial Gast/ Sleeve Gast

Lap only O&C unplanned

Morbidity

56

65

58

55

42

33

42

45

2

2

2

0% 20% 40% 60% 80% 100%

2008

2009

2010

2011

No Complications Complications Mortality n=136 - 2008

n=137 - 2009

n=149 - 2010

n=162 - 2011

Mortality – surgery 2011

76

69

0

0

0% 20% 40% 60% 80% 100%

Oesophagectomy

Gastrectomy

Surgery MortalityPlease note: above figs are actual. Open and close are not included

Pathological Stage by subtype0 5 10 15 20 25 30

Tis

HGD

T0N1

T1N0

T1N1

T1N2

T2N0

T2N1

T3N0

T3N1

T3N2

T2N2

T4N0

T3N3

T4N1

T4N2

T4N3

ACA SCCExcl. Carcinoid’s & Leioyoma’s excluded, 8 open and close excluded

Oesophageal Cancer: Treatment changeIntended Treatment Treatment Change nNeoadjuvant + Surgery Unfit for surgery 1

Neoadjuvant + Surgery Progression of disease, no surgery 4

Neoadjuvant + Surgery RIP (1 cycle) 0

Neoadjuvant + Surgery Moved to clinical trial 0

Neoadjuvant + Surgery Shortened chemotherapy due to toxicity 5

Magic + surgery No post-op chemo given due to chest pain 0

Neoadjuvant + Surgery Low GFR, no neoadjuvant given 2

Neoadjuvant + Surgery Patient declined 1

Surgery Not fit for surgery/patient declined 2

Chemoradiotherapy Not fit for CRT 1

Recruitment to trials - 2011

2

11 9

4

8

10 6

9

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

OE05 ST03 COUGAR-02 REAL3

FailRecruited

UGI Two Week Waits 2011

0

20

40

60

80

100

120

140

160

180

Jan

Feb

Mar

chApr

ilM

ayJu

ne July

Augus

t

Septe

mber

Octobe

r

Novem

ber

Decem

ber 2ww

31 day treats62 day treats62 day breaches

2 Week Waits - Comparison

11501325

1488 1489

0

200

400

600

800

1000

1200

1400

1600

2WW

2008200920102011

Breaches - Comparison

12

30.5

23

16

0

5

10

15

20

25

30

35

Breaches

2008200920102011

Issues?

• Re-haul of database– Now gives us what we need– Much more accurate

• Complications data much improved– Now introduced Clavien-Dindo/Accordian– Robust weekly system for collection of data on

complications

Why complicate things…