Our Partnership

A partnership between the National Cancer Registration and Analysis Service (NCRAS) and Transforming Cancer Services Team (TCST) was established in 2015. The partnership recognised that an investment in cancer analytics would enable commissioners and providers to accelerate improvements in cancer services and data across London. There are significant additional analyses that both parties have been interested in taking forward, but neither organisation has been able to progress for various reasons (including analytical capacity and access to data). Therefore the recruitment of three new cancer analysts to work jointly between NCRAS and TCST was agreed.

The availability of local analyses of nationally collated data will provide the opportunity to drive improvement in outcomes in London, both in quality of patient care and efficiency. Providing these analyses is the core focus of this partnership.

There is an established working relationship between NCRAS and TCST, through the collaboration on the NCRAS London work programme. This is currently managed by the NCRAS Senior Analyst, and is in collaboration with UCLH Cancer Collaborative, RM Partners, and south-east London, and this will continue.

Our Priorities  

NCRAS and TCST will agree strategic priorities and new areas of work in the context of the wider NCRAS and TCST work programmes, and the external environment. These should consider the wider London landscape, including the Vanguards and Integrated Cancer Systems.

The partnership aims to carry out analyses which will deliver a high quality, London-wide cancer analytical resource. The deliverables will fall into two categories: novel and derivative work. Novel work will evolve as the partnership develops, but the analysts will need to have close links to the clinical context through the pathway boards in the Integrated Cancer Systems, as well as to commissioners. Derivative work would be based on existing national reports but broken down into a more useful population / geography scale for London.

 Our Publication

 

Practice Profiles Plus 2019 Refresh: 

These Profiles provide a summary of the key cancer diagnosis and referral indicators for each practice or CCG within each England region. The Profiles enable comparisons to be made with other practices within a CCG, as well as with regional and national figures, to allow for benchmarking and to highlight variations. Each indicator is accompanied by a description of key contextual or influencing factors and provides information on local and/or national resources and initiatives which practices can draw on to help improve cancer outcomes. The Profiles have been refreshed to include data for the 19/20 financial year. For raw data methodology and further indicator definitions and methodology, see source website: http:/fingertips.phe.org.uk/profile/cancerservices.

 The purpose of the Profiles is to help practices reflect on their clinical practice and cancer service delivery, with a particular focus on symptom recognition and early diagnosis. It is not intended to be a measurement of performance. However, you may wish to review indicators which are significant outliers for your profile. As many indicators are influenced by factors such as age and deprivation, practices should review their Profile in conjunction with their demographic characteristics. The Profiles present crude rates which are not adjusted for demographic factors. However, each Profile also provides a practice index including additional demographic data to help provide context. A graph is provided for each indicator to visualise individual practices and how they are performing compared to the CCG, Region and England averages. Significance compared to the CCG average is also being shown with colour coding. CCGs can also be visualised comparing how they are preforming to the Region and England averages. Significance compared to the Region average being shown by colour coding. There are five years of historic data available for each indicator as historical data may wish to be reviewed to assess data trends for each indicator over time. Whilst the data in this tool is presented at the CCG level, individual practices may find it useful to visit the source website to see their individual practice data concisely presented. For further information regarding population size of each practice, and additional variables, for the most recent year please visit http://fingertips.phe.org.uk/profile/general-practice/data.

 Full interactive workbook Profiles for each region are available below:

 

  

 

 

Hospital Use and Cancer Treatment at the End of Life, for People Dying due to Cancer

An important component of good personalised care is to ensure that advance-planning and coordination of care at the end of life occurs as a shared decision-making process between an individual and their care providers. Data suggest there is still some way to go to implementing joint decision-making at the end of life well^1,2,3,4.

We have created an online dashboard and data workbook to describe metrics related to hospital use and cancer treatment in the last 90 days of life, for people diagnosed with cancer in London, where cancer was listed as the underlying cause of death.

The metrics described are:                                                 

• Location of death
• Occurrence of 3 or more emergency admissions to hospital
• Length of stay in hospital                                          
• Whether the patient received one or more of radiotherapy, chemotherapy or surgery

These are described for different population groups in London to understand where variation is occurring.

Further supplementary materials can be found in this workbook. The dashboard is accessed by clicking on the image, which will take you to a new site. It is best viewed in full-screen mode, which you can do by clicking on the icon at the bottom right of the dashboard.

1. Macmillan-commissioned YouGov Plc. survey to UK adults with a cancer diagnosis (2017) YouGov Plc.

2. Deaths Registered in England and Wales 2018, Office for National Statistics.

3 National Survey of Bereaved People (VOICES): England, 2015 Office for National Statistics.

4. Emergency Admission Data briefing (2018) Marie Curie 

Data in support of the Inequalities Toolkit for London:

As part of work performed by the TCST to develop an Inequalities Toolkit for London, the TCST-NCRAS Partnership has undertaken a series of analyses to assess demographic variation against the following cancer metrics for each of the 5 STPs in London and West Essex CCG:

• Routes to Diagnosis
• Stage at diagnosis
• Waiting times from referral to treatment, for those on a 62 day Cancer Waiting Times pathway

Additionally, unadjusted rates of cancer treatment with radiotherapy, chemotherapy and surgery were calculated for STPs in London to assess variation by STP of residence. This workbook contains the full range of results which, alongside the Inequalities Toolkit, can be used to support local areas to identify where variation occurs and develop local programmes for addressing inequalities in cancer care. 

 

                                                              

                

The cancer Screening Mapping Tool: 

The cancer screening mapping tool for London maps local screening initiatives against screening coverage for all screening programmes. Cancer screening coverage is generally lower in London than the national average, with wide variation between and within CCGs. Information about local initiatives to increase cancer screening participation accross London is presented following ongoing stakeholder engagement, and categorised as either 

• Evidence based – likely to increase screening participation
• An enabler – providing resources to support evidence-based initiatives but not shown on their own to have a significant impact on increasing screening rates

Accross London, variation in local provision for allscreening programmes is not currently linked to need. Enabler and evidence-based initiatives are not currently associated with better or worse screening covereage. However, iniotiatives were reported in 2019 and may not have been in place in teh period before March 2018, teh most recent covereage data.

Mapping tools for each screening programme can be viewed on the Healthy London Partnership website.

 

 

Cancer Prevelance Dashboard: 

The 2017 Prevalence Dashboard for London reveals that 231,740 people were living with a cancer diagnosis in London 2017. The dashboard breaks down the 2017 prevalence at CCG, STP and Cancer Alliance level, revealing the demographic makeup of the prevalent population in each geography (age, sex, ethnicity, socio-economic status). It also shows the completeness of QOF registers compared to the cancer registry, the proportion of patients living with a subsequent primary cancer, and forecasted growth of cancer prevalence to 2030.

The dashboard can be viewed on the Healthy London Partnership website.

 

Prevalence of Subsequent Primary Cancers (1995-2016):

People who have more than one primary cancer diagnosis may undergo multiple rounds of treatment and have more complex care needs. This project describes the prevalence of multiple primary cancers amongst those living with and beyond a cancer diagnosis at the end of 2016.

This workbook provides the 22-year prevalence (1995-2016) in England of having more than one primary cancer at Region, Cancer Alliance, STP and CCG level. Prevalence is further segmented by sex, age in 2016, ethnicity and deprivation quintile.

This slide-deck explores prevalent subsequent cancers across London in detail. The prevalence of subsequent primary cancers in London is described segmented by sex, age in 2016, ethnicity and deprivation quintile. Relationships between the site of first and subsequent tumours are explored according to sex, age and ethnic group. The time between a first and subsequent diagnosis is presented for different tumour site, sex and ethnicity groups. Overall, 4% of people living with and beyond cancer in London in 2016 had experienced subsequent primary cancers. Whilst the prevalence of subsequent cancers was higher for older cancer patients, there were no notable differences by other demographic and socioeconomic factors.

  

Variation in cancer incidence by ethnicity across London in 2015: 

This project assesses the estimated variation in cancer incidence by ethnicity and Sustainability and Transformation Partnership (STP) in London using population based registration data. Understanding cancer inequalities at local level provides STPs with the practical insight necessary for developing tailored services to improve cancer prevention, early diagnosis, treatment, and continuing care.

Cancer diagnoses in London 2012-2015 were identified and stratified by STP of residence, ethnicity, socio-economic deprivation, tumour group, age and stage at diagnosis. Descriptive analysis quantified variation by these factors.

Sex-specific age-standardised incidence rates were computed for 25 tumour groups by ethnicity for London and its STPs. Computation of Incidence-Rate-Ratios (IRRs) determined the likelihood of non-white ethnic groups being diagnosed with cancer relative to the White population. Results in this report focus on 2015 findings.

Full data tables (2012-2015) can be found in this workbook.

Key messages:

1. For the first time age-standardised cancer incidence rate estimates by ethnicity are available at STP level throughout London for 25 tumour groups.

2. There is considerable variation in cancer incidence by ethnicity, tumour group and STP.

3. For most cancers Asian, Black, Chinese and Mixed ethnic groups are significantly less likely or similarly likely to be diagnosed compared with the White population; but have an increased likelihood for certain cancers.

 

Segmented analysis of the colorectal cancer median pathway from referral to treatment: 2013-2015:

This project assesses the typical pathway for those diagnosed with colorectal cancer in London in the aim to understand the pathway better as this is a pathway that is typically challenged in terms of meeting the 62 day cancer waits standard.The pathway is presented by the median time taken between when a patient is referred to when they are first seen in secondary care, from when they are seen in secondary care to diagnosis, from diagnosis to the patient’s first MDT meeting, and from the MDT meeting to the treatment start date.The pathway is further segmented by year of diagnosis (2013-2015), sex, stage at diagnosis, age at diagnosis, ethnicity, income domain quintile, resident CCG and STP, and diagnosis trust.

Segmented analysis of the lung cancer median pathway from referral to treatment: 2013-2015:

This project assesses the typical pathway for those diagnosed with lung cancer in London in the aim to understand the pathway better as this is a pathway that is typically challenged in terms of meeting the 62 day cancer waits standard.The pathway is presented by the median time taken between when a patient is referred to when they are first seen in secondary care, from when they are seen in secondary care to diagnosis, from diagnosis to the patient’s first MDT meeting, and from the MDT meeting to the treatment start date.The pathway is further segmented by year of diagnosis (2013-2015), sex, stage at diagnosis, age at diagnosis, ethnicity, income domain quintile, resident CCG and STP, and diagnosis trust.

Segmented analysis of prostate cancer pathway from referral to treatment: 2013-2015: 

This project assesses the typical pathway for those diagnosed with prostate cancer in London in the aim to understand the pathway better as this is a pathway that is typically challenged in terms of meeting the 62 day cancer waits standard.

The pathway is presented by the median time taken between when a patient is referred to when they are first seen in secondary care, from when they are seen in secondary care to diagnosis, from diagnosis to the patient’s first MDT meeting, and from the MDT meeting to the treatment start date.

The pathway is further segmented by year of diagnosis (2013-2015), stage at diagnosis, age at diagnosis, ethnicity, resident CCG and STP, and diagnosis trust.

 

Cancer Prevalence in England - 21 year prevalence by demographic measures at Local Authority:

This workbook is an extension of the 21-year prevalence work mentioned below. This workbook provides the 21-year prevalence estimate at Local Authority for: Time since diagnosis, Deprivation, Ethnicity, Stage at diagnosis, Age at diagnosis and Age in 2015. This work was completed in partnership between TCST, Macmillan Cancer Support and NCRAS.

Cancer Prevalence in England - 21 year prevalence by demographic and geographic measures:

This workbook provides an update to previous work produced by Macmillan Cancer Support that has looked in detail at the prevalent cancer population living until the end of 2010. This update provides views by more demographic measures and new sub-national geographies such as cancer alliance and STP.

Data is provided for cancer prevalence in England from 1995-2015 who are alive on the 31st December 2015. The data is presented by sex and cancer type, and by either time since diagnosis, age at diagnosis, age in 2015, deprivation, ethnicity (10 year), or stage at diagnosis (4 year). It is presented for the following geographies: England, region, cancer alliance, sustainability and transformation partnership (STP), and clinical commissioning group (CCG).

This workbook is carried out in partnership with Macmillan Cancer Support.

 

Comorbidity at diagnosis for those living with cancer in London: 

Comorbidity at diagnosis may impact the effectiveness and delivery of cancer treatment, survival outcomes and quality of life of cancer patients. This study explores the variation in serious comorbidity at the time of cancer diagnosis in people living in London.

This workbook presents data on twenty year prevalence by Charlson comorbidity index score and stratified by geography, sex, socio-economic deprivation, tumour site, age, and years since diagnosis. This work provides valuable new intelligence in understanding differing demographics and needs of patients with various levels of comorbidity. 

 

Repeat Diagnostics for Lung Cancer in London:

This project investigated whether repeat diagnostic imaging during the patient pathway is occurring by making use of the existing Diagnostic Imaging Dataset (DID). Lung cancers (C33 and C34) diagnosed in London and West Essex during 2013 and 2014 recorded in the National Cancer Registry were linked to DID records. Repeat diagnostics may be indicative of either a complex diagnosis in the patient, which should be relatively rare, or an inefficient pathway. The latter would not represent the best experience for the patient or use of diagnostic capacity and resources.

Descriptive data is provided on the volume of imaging, referral source, sex, median age, stage at diagnosis, and time delay between imaging procedure and diagnosis. This data is segmented by the number of diagnostic images, clinical commissioning group, strategic transformation plan, year, and imaging modality.

Pathway analysis was carried out, segmented by imaging modality and year, to evaluate patterns by London trust on where preceding and subsequent images were being carried out, and to assess the patterns in repeating imaging by referral pathway.

Following a meeting to discuss the findings of the work with the lung cancer lead for NCRAS, we would like to highlight the following points for consideration when reviewing the results:- Repeat procedures may be requested if the previous image was carried out more than a month prior, to assess for change before making the treatment decision- Repeat chest CT scans are often requested if the previous chest CT image is not of high quality or if the previous image was not a contrast enhanced chest CT scan- Future analytical work investigating the proportion of repeat images where the repeat image carried out was a contrast chest CT scan, and the preceding image was a plain chest CT scan as an explanation as to why repeat chest CT scans may occur is being considered.

This work was carried out in collaboration with Cancer Research UK. 

 

Maps of all sites, breast, colorectal, lung and prostate cancer diagnosis by stage and ethnicity in London, 2012 – 2014:  

Heat maps have been created to show the presentation of all sites, breast, colorectal, lung and prostate cancers by ethnicity and stage for the 32 CCGs in London and West Essex CCG, 2012–2014. For ethnicity presentation at cancer diagnosis, all sites were segmented into those of Asian, black, white, other, and unknown ethnicity. For stage at cancer diagnosis, all cancer sites were presented as stage I, II, III, and IV whilst for breast, colorectal, lung, and prostate cancers stage were presented as early (stage I and II), advanced (stage III and IV), and unknown stage. For both ethnicity and stage data quality appears to improve over the time period. 

 

Cancer bed use analysis across London Trusts:

A large project has been undertaken on the bed usage for cancer patients across London trusts.  There are a number of reasons that commissioners and providers need to understand this, with the aim of understanding variation and progress over time.  The reasons include:

- Reducing the length of elective surgical admissions and associated readmissions, including, in some instances, moving to day-case surgery to make services more cost effective against tariff and also to release provider capacity.

- Reducing the number and length of elective medical admissions, particularly those under haematologists or medical/clinical oncologists.  In some instances this may mean avoiding inpatient admissions altogether by providing care in ambulatory settings.

- Reducing the number of emergency admissions due to side effects of treatment (such as chemotherapy or radiotherapy) or progressive disease. The aim is that, with more proactive management of patients’ symptoms and side effects, and with better patient education, problems can be identified early and managed on an ambulatory basis and emergency admissions avoided.  

Findings from this project will be delivered in multiple outputs:

1) Admissions:  This workbook shows data on inpatient bed use by cancer patients in London and West Essex, showing the overall number of admissions and the length of stay with a breakdown by tumour type, CCG and provider.

2) Specialty:  This workbook shows data on inpatient bed use by cancer patients in London and West Essex, showing the overall number of admissions and the length of stay with a breakdown by specialty, CCG and provider.

 

 

For further TCST resources please see the MyHealthLondon website.

 

Our Progress

2020	The Cancer Screening Mapping too is updated to include more recent and detailed data on screening interventions '2017 London Cancer Prevalence Dashboard' is presented at BJGP Conference Hospital Use and Cancer Treatment in the last 90 days of life  dashboard is published
2019	Data in support of the Inequalities toolkit for London is published Practice Profiles Plus is refreshed for 2019 to include 2017/18 data The Cancer Screening Mapping tool is published. The tool maps local cancer screening initiatives to date against screening coverage for each cancer screening prgramme accross London. The 2017 Cancer Prevalence Dashboard for London is published. The dashboard breaks down the 2017 prevalence at CCG, STP and Cancer Alliance level, revealing the demographic makeup of the prevalent population in each geography
2018	Prevalence of Subsequent Primary Cancers (1995-2016) workbook and slide-deck published ‘Variation in Cancer Incidence by Ethnicity’ presented at NCRI conference ‘Variation in Cancer Incidence by Ethnicity’  and ‘Comparison of Comparison of cancer prevalence data sources: National Cancer Registry and Primary Care Registers’ are presented at the Public Health England Annual Conference.  Practice Profiles Plus is refreshed for 2018 to include 2016/17 data.Breakdowns for all CCGs and STPS in England are provided for the first time. Report on variations in cancer incidence by ethnicity across London in 2015 is published Segmented analysis of the colorectal and lung cancer pathways from referral to treatment: 2013-2015 are published.
2017	Segmented analysis of the prostate cancer median pathway from referral to treatment: 2013-2015 is published. A workbook on Cancer Prevalence in England: 21 year prevalence by demographic and geographic measures is published. Understanding the current cancer population in England: detailed prevalence estimates is presented at the International Association of Cancer Registries conference in Utrecht, The Netherlands. Practice Profiles Plus, Association of prevalence and comorbidities at diagnosis for those living with cancer in London, and Prevalence of subsequent primary tumours with demographic variation for those living with cancer in London are presented as posters at the PHE annual conference. A workbook on comorbidity at diagnosis for those living with cancer in London is published. This work is presented at the PHE Cancer Data and Outcomes Conference in the same month. Practice Profiles Plus refreshed to include 15/16 data. Practice Profiles Plus is presented as an oral presentation at the Cancer Research UK Early Diagnosis Conference. The workbook on repeat diagnostics for lung cancer in London is published.
2016	Recruitment of three analysts to begin work on the partnership priorities. Practice Profiles Plus to be launched and circulated to stakeholders, GP facilitators and GPs. Maps of London created showing the variation of stage at diagnosis and ethnicity by CCG for 2012–2014 which will be delivered to commissioners. Start of the project researching the lung cancer diagnostic pathway in London. The aim of the project is to map the diagnostic pathway for those with lung cancer in London, and to develop a measure identifying multiple diagnostics within the pathway. Start of the London Older Persons report based on the previous Older People and Cancer report published at a national level (NCIN , 2015). The aim of the project is to highlight areas of variation in access and care in older persons in London. Start of project to create an automated version of Practice Profiles Plus to be circulated to CCGs and GP facilitators, and any interested stakeholders.